骶髂关节紊乱与腰椎间盘退变之间相关性的流行病学研究与生物力学分析

Epidemiology investigation and biomechanics analyses for the correlation between sacroiliac joint disorder and lumbar intervertebral disc degeneration

目的：研究骶髂关节紊乱与腰椎间盘退变之间的相关性，为慢性顽固性腰腿痛的防治提供一个新的认识理念和临床治疗途径。方法：自2009年8月至2010年10月，采用流行病学调查的方法研究129例腰椎间盘突出症患者。L4.5椎间盘突出症患者61例，男37例，女24例；年龄20～75岁；病程1～144个月。L5S1椎间盘突出症患者68例，男32例，女36例；年龄18～76岁；病程0．5～240个月。流行病学调查患者的一般临床资料、症状与体征，以及腰椎与骨盆在X线片的表现形式。病例对照研究的方法计算骶髂关节紊乱对腰椎间盘突出症发病的危险度；单因素危险度估计对自变量进行筛选，Logistic回归分析确定腰椎间盘突出症的危险因素，并进行生物力学分析。结果：129例腰椎间盘突出症患者中88例合并有骶髂关节紊乱，骶髂关节紊乱是腰椎间盘突出的危险因素之一（OR=4．61，P=0．00）；61例L5S1椎间盘突出症患者中47例合并骶髂关节紊乱，髂骨旋转移位引起的髂嵴不平为L4．，椎间盘突出症的高危险因素（OR=11．27，P=0．00）；68例L5S1椎间盘突出症患者中41例合并骶髂关节紊乱，骶骨倾斜移位引起的腰骶角异常为L5S1椎间盘突出症的高危险因素（OR=2．31，P=O．03）。结论：骶髂关节紊乱与腰椎间盘突出症是二联症，二者相互影响且有因果关系，任何一方的发生是另一方发生的原因和结果，共同存在于腰腿痛疾病中。

To study the correlation between lumber disc degeneration and sacroiliac joint disorder, in order to provides a new understanding concepts and therapeutic approach for the prevention and treatment of chronic intractable low back pain. Methods：From August 2009 to October 2010,129 cases with lumbar disc herniation were studied with epidemio- logical methods. Among them, 61 patients with L4.5 disc herniation included 37 males and 24 females, ranging in aged from 20 to 75 years old, duration of the disease ranged from 1 to 144 months ; The other 68 patients with L5S1 disc herniation included 32 males and 36 females,ranging in aged froml8 to 76 years old,duration of the disease ranged from 0.5 to 240 months. The clinical data, symptoms and signs ,X-ray characteristics of lumbar spine and pelvis of the patients were investigated by epi- demiological. The risk of lumbar disc herniation was calculated with case-control study ; independent variables were screened with single factor analysis ;the risk factors for lumbar disc herniation were determined with logistic regression analysis,and biomeehanies analyses were taken. Results：Among 129 patients with lumbar disc herniation, 88 cases associated with sacroili- ac joint disorders, sacroiliac joint disorder was a risk factor of lumbar disc herniation （ 0R=4.61, P=-0.00） ; 47 cases associated with sacroiliac joint disorders in 61 patients with L4.5 disc herniation, iliae crest uneven caused by iliac rotational displacement was a high risk factor of L4.5 disc herniation （OR=I 1.27 ,P=0.00） ;41 cases associated with sacroiliac joint disorders in 68 pa- tients with L5S1 disc herniation, lumbar sacral angle abnormalities caused by sacral tilt shift was a high risk factor L5S1 disc her- niation （0R=2.31,P=0.03 ）. Conclusion： Lumbar disc herniation and sacroiliac joint disorder are two of fallot, the two factors affect each other and there is a causal relatlonshin. They are common exists in low back nain.