局部生物力学因素在L_5/S_1椎间盘突出症发病中的作用

Role of local biomechanical factors in pathogenesis of L_5/S_1 disc herniation

背景:近年来,有关生物力学因素与腰背痛关系的报道大多集中在腰椎整体生物力学与腰背痛的研究上,而针对局部生物力学特点与单纯腰椎间盘突出的研究则较少。目的:探讨局部生物力学因素在L5/S1椎间盘突出症发病中的作用。方法:共纳入对象124例,包括椎间盘突出症组和对照组,62例/组。椎间盘突出症组为2008-06/2009-07于青岛大学医学院附属医院诊断明确并行手术治疗的L5/S1椎间盘突出症患者;对照组为健康体检人员。在腰椎正侧位X射线片上测量和观察各组L5椎体相对深度、腰骶移行椎、L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角的变化。结果与结论:与对照组比较,椎间盘突出症组L5椎体相对深度明显增加(P<0.01),椎间盘突出症组腰骶移行椎数目明显降低(P<0.01),说明相对位置较深的L5椎体及腰骶移形椎可能对L5/S1椎间盘具有保护作用,可降低L5/S1椎间盘突出症的发生率。椎间盘突出症组腰骶角和骶骨水平角明显减小(P<0.01);但L5/S1骶骨垂直角和椎间盘相对高度在椎间盘突出症组与对照组之间差别无显著性意义(P>0.05),可见,L5/S1椎间盘相对高度、腰骶角、骶骨水平角和骶骨垂直角与椎间盘突出的关系仍不明确,需进一步探讨。

BACKGROUND：The relationship between biomechanical factors and low back pain has been extensively studied in recent years,but mostly focus on unitary biomechanics characters and low back pain.There are few studies with regard to partial biomechanical factors and L5/S1 disc herniation.OBJECTIVE：To explore the role of biomechanical factors in pathogenesis of L5/S1 disc herniation.METHODS：Totally 124 cases were included in the study.All cases were divided into the disc herniation group and control groups,with 62 cases in each group.The disc herniation group consisted of L5/S1 herniation patients received treatment at the Affiliated Hospital of Medical College of Oingdao University,and the healthy examination cases were served as controls.The indicator included relative depth of lumbar 5 vertebra,lumbosacral transitional vertebra,relative height of L5/S1 disc,lumbosacral angle,sacral horizon angle and sacral Inclination angle.The difference of the indicators between the two groups was analyzed statistically.RESULTS AND CONCLUSION：The relative depth of L5 vertebra of the disc heniation group was significantly higher than the control group（P〈0.01）,and the number of lumbosacral transitional vertebra of disc heniation group was significantly fewer than the control group（P〈0.01）,which indicated that the deep-seated lumbar 5 vertebra and lumbosacral transitional vertebra might protect L5/S1 disc and reduce the incidence of L5/S1 disc herniation.Lumbosacral angle and sacral horizon angle of disc herniation group were significantly lower than that of control group（P〈0.01）,but there was no significant statistical sense in the difference of sacral inclination angle between the two groups（P〉0.05）,and there was no significant statistical sense in the difference of relative height of L5/S1 disc（P〉0.05）,which indicated the roles of relative height of L5/S1 disc,lumbosacral angle,sacral horizon angle and sacral inclination angle in L5/S1 disc herniation still need further study.