退变性脊柱侧凸椎间盘-终板退变与骨性结构参数的相关性研究及意义

Correlation between intervertebral disc-endplate degeneration and bony structural parameter in adult degerative scoliosis and its significance

目的分析退变性脊柱侧凸椎间盘-终板退变与骨性结构参数的关系，探讨其在退变性脊柱侧凸发病机制中的作用及意义。方法回顾分析2005年3月至2010年3月诊治的79例退变性脊柱侧凸患者（病例组）的影像学资料，选取41例诊断为特发性脊柱侧凸患者（对照组）的影像学资料做为对照。所有患者以主弯内的椎体及附件为观测对象，分别测量椎体和椎间两侧高度及两侧关节突关节面矢状角角度，分别计算椎体和椎间两侧平均高度及两侧关节突关节面平均矢状角作为骨性结构参数。采用分级评分法对各个椎间盘及邻近终板退变程度进行量化，其分值代表椎间盘-终板退变的程度。组内比较各骨性结构参数，分析骨性结构参数的特点及其与椎间盘一终板退变和侧凸Cobb角的关系。结果经配对t检验比较，病例组的椎间高度、椎体高度及关节面矢状角凸凹侧差异有统计学意义（t=3．411，2．623和2．085，P〈0．05）；对照组的椎间高度凸凹侧差异有统计学意义（t=3．276，P〈0．01），椎体高度及关节面矢状角差异无统计学意义（t=1．572和1．493，P〉0．05）。直线相关和多元回归分析显示，各骨性结构参数不对称度与椎间盘－终板退变有显著相关性（－1〈r〈1，P〈0．05），与腰椎侧凸Cobb角呈正相关（0〈r〈1，P〈0．05），且存在直线回归关系（F=427．342，P〈0．01），其回归方程为Cobb角=－8．904＋8．136×椎间不对称度＋3．274X椎体不对称度－0．713×关节突不对称度。结论退变性脊柱侧凸两侧骨性结构呈不对称改变，其不对称性与椎间盘．终板退变和脊柱侧凸相互关联；不对称骨性结构改变可能是侧凸渐进性发展的生物力学动力因素，而椎间盘-终板不对称退变可能有病因学意义。

Objectives To anylaze the correlation between intervertebral disc-endplate degeneration and bony construction parameter and to explore its roles in adult degenerative scoliosis. Methods The imaging data of 79 patients with adult degenerative scoliosis from March 2005 to March 2010 were retrospectively reviewed as the study group. The imaging data of 41 patients with adolescent idiopathic scoliosis were selected as the control group. The vertebral body and intervertebral height in both sides on frontal X-ray, and the facet joint orientation in both sides on CT scan were measured respectively. The average vertebral body height, average intervertebral disc height and average facet orientation were regarded as bony structural parameters. The quantitative grading methods were used in the intervertebral disc and endplate degeneration. The relationship of bony construction parameter and intervertebral disc-endplate degeneration, and the relationship of bony construction parameter and Cobb＇s angle of scoliosis were analyzed by comparing all bony construction parameters in both groups. Results Analyzed by paired-t test, the intervertebral height, vertebral body height and facet joint orientation between convex and concave sides of the study group were of significant difference（ t = 3.411, 2. 623 and 2. 085 ,P 〈 0. 05 ）. The intervertebral height between convex and concave sides of the control group were of significant difference（ t = 3.276, P 〈 0. 01 ）, while the vertebral body height and the facet joint orientation were of no statistical significance（ t = 1. 572 and 1. 493, P 〉 0. 05）. By linear correlation and regression analysis, the asymmetric degree of bony construction parameter showed good correlation with the score of intervertebral disc-endplate degeneration （ - 1 〈 r 〈 1, P 〈 0.05 ） , which was positively correlated with Cobb＇ s angle of seoliosis （ 0 〈 r 〈 1, P 〈 0. 05 ）. Linear regression existed between asymmetric degree of bony construction parameter and Cobb＇s angle（F =427. 342,P 〈 0. 01 ）. The regression function was obtained： Cobb＇s angle = - 8. 904 ＋ 8. 136 × IAD ＋ 3. 274 ×VAD - 0. 713 ×FAD （ lAD： intervertebral asymmetry degree, VAD： vertebral asymmetry degree, FAD：facet joint asymmetry degree）. Conclusions The asymmetric change of bony construction exists in adult degenerative scoliosis, whicb significantly correlated with intervertebral disc-endplate degeneration and Cobb＇s angle of scoliosis. The asymmetric bony construction parameter probably plays a biomechanieal role in the progression of scoliosis, which maybe the reason for the asymmetric degeneration of intervertebral disc-endplate.