腰椎相关结构退变规律的研究分析

Study on the law of the structural degeneration of lumbar spine

目的探讨腰椎相关结构的退变规律。方法对983例腰椎退变患者X光及CT片资料进行分析，观察椎体、椎间盘、椎小关节、韧带退变及退变性腰椎失稳情况，统计不同年龄段、不同性别及不同节段腰椎相关结构的退变率。结果983例腰椎退变患者中，腰间盘退变率最高（65．1％），其余依次为椎体（53．4％）、椎小关节（35．5％）、韧带（28.4％）、腰椎失稳（25．7％）；40岁以下为腰椎退变低发生年龄，且以椎问盘退变为主，40岁以上为腰椎相关结构总体退变高发生年龄；男性椎间盘、椎体退变率高于女性，椎小关节、韧带退变率男、女间无显著差异，女性腰椎失稳率高于男性；L4-5节段的退变率最高（73．1％），其余依次为L5-S1（62．7％）、L3-4（48．9％）、L2-3（30．8％）节段。结论腰椎退变伴随年龄增长而递增，其不同结构退变规律并不一致，但在退变过程中又互为因果，相互影响，诱发、加速和加重彼此退变的进程，充分了解腰椎相关结构退变规律，对临床预防、诊治腰椎退变起着关键性的作用。

Objective To explore the law of the degeneration of lumbar spine related structures. Methods X-ray and CT data of 983 patients with lumbar spine degeneration were analyzed, the degenerative diseases of lumbar vertebral bodies, intervertebral discs, facet joints, ligaments and degenerative instability of lumbar spine were observed, the degeneration rate of lumbar spine related structures in different ages, genders and segments were calculated. Results In983 cases of lumbar spine degeneration, the degeneration rate of lumbar disc was the highest （65.1%）, followed by vertebral body （53.4%）, vertebral facet joint （35.5%）, ligament （28.4%） and lumbar instability （25.7%）. Patients whose age below 40 years old had a lower incidence of lumbar spine degeneration, and the disc degeneration was the main; patients whose age over 40 years old had a higher incidence of lumbar spine degeneration. The degeneration rate of lumbar intervertebral disc and vertebral body in male were higher than those in female, there were no statistically significant differences in the degeneration rate of intervertebral joint and ligament between male and female, the lumbar degenerative instability rate in female was higher than that in male. The degeneration rate of L4-5 segment was the highest （73.1%）, followed by L5-S1 segment （62.7%）, L3-4 segment （48.9%）, and L2-3 segment （30.8%）. Conclusions The lumbar spine degeneration increases accompanied by age increases, and its degeneration of different anatomical structure is not consistent, but they are reciprocal causation and mutual influence in the process of degeneration, induce, accelerate and aggravate the process of degeneration each other. Fully understanding the law of lumbar spine related structural degeneration plays a key rote in the prevention and treatment of lumbar spine degeneration.