磁共振测量腰骶椎矢状面参数与L_5/S_1椎间盘退变的关系

Lumbosacral sagittal parameters measured by magnetic resonance in association to L_5/S_1 intervertebral disc degeneration

背景:以往已有一些关于腰骶椎矢状面参数与腰椎间盘退变性疾病相关性的报道,但试验对象多是笼统的椎间盘突出的患者,试验数据也多是在X射线片或CT上测得,而从磁共振成像得的腰骶段矢状面参数与出现腰骶椎间盘脱出的手术病例的相关性报道则较少见。目的:磁共振测量和评价出现腰骶椎间盘脱出患者的腰骶矢状面参数变化,分析腰骶矢状面参数与椎间盘退变性疾病之间的关系。方法:回顾性分析自2014年9月至2016年4月间上海第二军医大学附属长海医院骨科18-35岁腰痛患者90例,按有无L_5/S_1椎间盘突出分为无椎间盘突出组69例和脱出组21例,其中因L_5/S_1椎间盘脱出并行手术治疗的21例,其他69例为无椎间盘突出组;无椎间盘突出组按有无L_5/S_1椎间盘退变又分为退变组和对照组,其中仅有L_5/S_1椎间盘退变的35例作为退变组,剩余34例无椎间盘病变的作为对照组。测量的腰骶矢状面参数包括腰椎前凸角、骶骨平台角、腰骶关节角。结果与结论:与对照组相比,退变组腰椎前凸角虽有减小但差异并不显著(P>0.05),而骶骨平台角及腰骶关节角均有明显减小(P<0.05)。与无椎间盘突出组对比,椎间盘脱出组腰椎前凸角、骶骨平台角及腰骶关节角均显著减小(P<0.05)。结果说明,腰椎前凸角仅在出现椎间盘脱出的年轻成年男性病例中显著减小,而在椎间盘退变的病例并不明显;骶骨平台角和腰骶关节角的减小与椎间盘退变性疾病密切相关,是临床评价腰骶矢状面平衡的重要参数。

BACKGROUND： Many studies have investigated the relationship between lumbosacral sagittal parameters and the disc degeneration diseases. However, the objects of these studies were mainly the patients with disc herniation, and parameters were measured on CT or X-ray. There are few publications reporting the relationship between lumbosacral sagittal parameters, which were measured on MRI, and patients who underwent surgery with disc extrusion. OBJECTIVE： To measure and compare the lumbosacral sagittal parameters in L5/S1 disc extrusion patients, and to investigate the relationship between the lumbosacral sagittal parameters and L5/S1 disc degeneration diseases. METHODS： A total of 90 lumbago patients aged 18 to 35 years old were included from the Department of Orthopedics, Changhai Hospital Affiliated to The Second Military Medical University from September 2014 to April 2016 for retrospective analysis. According to with or without L5/S1 intervertebral disc protrusion, they were divided into intervertebral disc herniation group（69 cases） and disc extrusion group（21 cases received surgery）. The intervertebral disc herniation group was subdivided into degeneration group（35 cases） and control group（34 cases） according to with or without L5/S1 degeneration. Angles of lumbar lordosis（LL）, sacral table angle（STA） and lumbosacral angle（LSA） were measured. RESULTS AND CONCLUSION： Compared to the control group, the difference of LL was not significant in the degeneration group（P〉0.05）, but STA and LSA were significantly reduced（P〈0.05）. Compared with the no-disc herniation group, LL, STA and LSA were all decreased significantly in the disc extrusion group（P〈0.05）. These results confirmed that LL in young adults with disc extrusion decreased significantly, however, in patients with disc degeneration, the decrease was not significant. The decrease in STA and LSA was strongly associated with disc degeneration diseases. STA and LSA are important parameters in the clinical evaluation of lumbosacral sagittal balance.