腰椎退行性疾病矢状面失衡及结构因素研究

A study on sagittal balance disorders and structural factors in degenerative lumbar spine

目的研究腰椎矢状面失衡和结构因素与腰椎退行性疾病发病的关系。方法 2012年7月—2015年5月将符合诊断标准的患者按破裂型腰椎间盘突出、单纯退变型腰椎间盘突出、腰椎退行性滑脱和非特异性下腰痛分组,每组按就诊时间顺序纳入40例,所有患者行腰椎X线片、CT、MRI检查,测定矢状参数和评价结构等级,分析各组间差异。结果 4组间骨盆入射角(pelvic incidence,PI)、腰椎前突角(lumbar lordosis,LL)差异均有统计学意义(P<0.05),其中PI平均值从大到小依次为:退变滑脱组、退变型突出组、非特异性下腰痛组、破裂型突出组;LL平均值从大到小依次为:退变滑脱组、非特异性下腰痛组、退变型突出组、破裂型突出组。4组间骶骨倾斜角、骨盆倾斜角差异均无统计学意义(P>0.05)。4组间腰椎间盘退变程度的差异有统计学意义(P<0.05),非特异性下腰痛组退变程度最轻,与其他3组比较差异有统计学意义(P≤0.001),其余3组间退变程度和退变率差异均无统计学意义(P>0.05)。4组间关节突关节退变程度的差异有统计学意义(P<0.05),非特异性下腰痛组腰椎关节突关节退变程度最低,与其他3组比较差异有统计学意义(P<0.001);其余3组间关节突关节退变分级比较,差异无统计学意义(P>0.05),但破裂型突出组与退行性滑脱组关节突退变率差异有统计学意义(χ2=11.429,P=0.001)。结论腰段脊柱形态越是垂直,越容易发生腰椎间盘破裂型突出,同时腰椎关节突关节退变程度越轻;腰段脊柱形态越是弯曲越容易发生退变性滑脱,同时腰椎关节突关节退变程度也越严重。非特异性下腰痛者腰椎间盘和腰椎关节突关节退变程度均最轻。

Objective To explore the relationship between imbalance in sagittal plane as well as structural factors and lumbar degenerative disease. Methods Patients diagnosed between July 2012 and May 2015 were divided into 4 groups according to corresponding diagnostic criteria： lumbar disc herniation group （LDH）, lumbar disc protrusion group （LDP）, degenerative lumbar spondylisthesis group （DLS） and nonspecific low back pain group （NLBP）; 40 patients were included in each group according to their visiting time. All patients underwent X-ray, CT, and MRI. Sagittal parameters and evaluate degeneration level of structural factors were measured, and the difference among the groups were analyzed. Results There was statistical significance in differences of pelvic incidence （PI） and lumbar lordosis （LL） among 4 groups （P〈0.05）. Average PI was followed in descending order： DLS, LDP, NLBP, and LDH; average LL was followed in descending order： DLS, NLBP, LDP, and LDH. There was no statistical differences in sacral slope and pelvic tilting among 4 groups （P〉0.05）. The difference in the level of lumbar disc degeneration between NLBP group （which had slightest lumbar disc degeneration） and the other groups was significant （P〈0.001） while no statistical differences in level and rate of lumbar disc degeneration among the other three groups was found （P〉0.05）. As to the level of lumbar zygapophyseal joint degeneration, there was statistical differences between NLBP group （which had the lowest level of lumbar zygapophyseal joint degeneration） and the other groups （P〈0.001） while no statistical differences in the grade of lumbar zygapophyseal joint degeneration among the other three groups （P〉0.05）. There was statistical differences in the rate of lumbar zygapophyseal joint degeneration between LDH and DLS group （χ2=11.429,P=0.001）. Conclusions Vertical lunbar spine is combined with LDH of which the level of lumbar zygapophyseal joint degeneration is minimized, while crooked lunbar spine is combined with DLS of which the level of lumbar zygapophyseal joint degeneration is maximization. NLBP has the lowest level of degeneration of lumbar disc and lumbar zygapophyseal joint degeneration.