腰椎间盘突出症的复发与腰椎曲度的关系

Clinical study on the relationship between recurrence of lumbar disc herniation and curvature of lumbar vertebrae

目的:探讨腰椎间盘突出症的复发与腰椎曲度的关系。方法:将经手法治疗后治愈且获得1年随访的90例腰椎间盘突出症患者分为2组,症状复发的45例患者纳入观察组,症状未复发的45例患者纳入对照组。分别在治疗后及随访1年时摄腰椎侧位X线片,在X线片上分别测量腰椎曲线指数、腰椎前凸角度及骶骨倾斜角,并作组间比较。结果:治疗后2组患者的腰椎曲线指数、腰椎前凸角度、骶骨倾斜角比较,组间差异均无统计学意义[(10.27±1.35)mm,(10.24±1.27)mm,t=0.275,P=0.886;(43.02°±1.16°),(42.34°±1.57°),t=0.262,P=0.935;(40.04°±3.67°),(40.45°±3.75°),t=0.131,P=0.736];随访1年时,观察组患者的腰椎曲线指数、腰椎前凸角度、骶骨倾斜角均小于对照组患者[(6.18±1.07)mm,(8.50±0.63)mm,t=12.533,P=0.001;(30.54°±1.40°),(40.45°±1.17°),t=36.435,P=0.000;(35.01°±4.19°),(38.02°±4.16°),t=3.417,P=0.019];观察组患者随访1年时与治疗后腰椎曲线指数、腰椎前凸角度及骶骨倾斜角的差值均大于对照组[(4.06±0.72)mm,(1.78±0.65)mm,t=60.135,P=0.000;(12.12°±0.56°),(2.31°±0.46°),t=77.655,P=0.000;(5.37°±1.23°),(2.02°±1.29°),t=72.365,P=0.000]。结论:腰椎曲线指数、腰椎前凸角度及骶骨倾斜角小,腰椎间盘突出症容易复发。

Objective：To explore the relationship between recurrence of lumbar disc herniation（LDH） and curvature of lumbar vertebrae.Methods：Ninety patients with LDH who were cured after spinal manipulation and followed up for one year were randomly divided into two groups.Forty-five patients with recrudescent symptoms of LDH were recruited into the observation group,while 45 patients without recrudescent symptoms of LDH were recruited into the control group.Lumbar lateral x-ray films were taken after the treatment and after oneyear follow-up respectively,then the index of lumbar spinal curvature,lumbar lordosis angle and sacrum slant angle were measured from xray images and were compared between the 2 groups.Results：There were no statistical differences in the index of lumbar spinal curvature,lumbar lordosis angle and sacrum slant angle between the 2 groups respectively after the treatment（10.27 ＋/-1.35 vs 10.24 ＋/-1.27 mm,t =0.275,P =0.886 ;43.02 ＋/-1.16 vs 42.34 ＋/-1.57 degrees,t =0.262,P =0.935 ;40.04 ＋/-3.67 vs 40.45 ＋/-3.75 degrees,t =0.131,P =0.736）.After one-year follow-up,the index of lumbar spinal curvature,lumbar lordosis angle and sacrum slant angle of the observation group were less than that of the control group （6.18 ＋/-1.07 vs 8.50 ＋/-0.63 mm,t =12.533,P =0.001 ;30.54 ＋/-1.40 vs 40.45 ＋/-1.17 degrees,t =36.435,P =0.000;35.01 ＋/-4.19 vs 38.02 ＋/-4.16 degrees,t =3.417,P =0.019）.The differences between one-year follow-up and post-treatment of the observation group were larger than that of the control group in the index of lumbar spinal curvature,lumbar lordosis angle and sacrum slant angle （4.06 ＋/-0.72 vs 1.78 ＋/-0.65 mm,t =60.135,P =0.000 ; 12.12 ＋/-0.56 vs 2.31 ＋/-0.46 degrees,t =77.655,P =0.000 ; 5.37 ＋/-1.23 vs 2.02 ＋/-1.29 degrees,t =72.365,P =0.000）.Conclusion：LDH is likely to relapse when the index of lumbar spinal curvature,lumbar lordosis angle and sacrum slant angle are small.