中青年腰椎压缩骨折对相邻椎间盘退变影响的初步研究

Early stage adjacent disc degeneration after lumbar compression fractures in younger patients

目的探讨中青年(年龄<60岁)腰椎压缩骨折对相邻椎间盘退变的影响。方法收集自2009-01—2013-12诊治的37例单纯腰椎压缩骨折作为观察组,未行系统治疗或椎体未获得良好复位。收集同期行椎弓根内固定术后骨折获得良好复位的42例单节段腰椎骨折作为对照组。在X线片上测量腰椎椎体前缘与后缘高度,确定椎体楔形变程度;MRI T2加权像及抑脂序列矢状位上对楔形变椎体相邻椎间盘行Pfirrmann分级。结果观察组获得(5.3±0.3)年随访,对照组获得(5.8±0.2)年随访。骨折早期椎间盘退变分级:观察组Ⅰ度26例,Ⅱ度9例,Ⅲ度2例,退变率29.72%;对照组Ⅰ度29例,Ⅱ度12例,Ⅲ度1例,退变率30.95%;2组椎间盘退变率差异无统计学意义(χ2=0.014,P=0.763)。末次随访时椎间盘退变分级:观察组Ⅰ度6例,Ⅱ度6例,Ⅲ度19例,Ⅳ度5例,Ⅴ度1例,退变率83.78%;对照组Ⅰ度25例,Ⅱ度13例,Ⅲ度4例,退变率40.48%;观察组椎间盘退变率高于对照组,差异有统计学意义(χ2=15.474,P=0.003)。结论腰椎压缩骨折后未行系统治疗或椎体未获得良好复位可能加速骨折椎体相邻椎间盘退变。

Objective To investigate influence of the lumbar compression fracture on degeneration of the adjacent discs in patients less than 60 years old. Methods From January 2009 to December 2013, 37 patients with simple compression fracture of lumbar vertebra were enrolled in study group. All the patients in study group were treated conservatively or not treated without good reduction. At same time, 42 patients were performed pedicle screw fixation in control group, the fractured vertebral deformity were better corrected by operation. The height of degenerative disc was measured on X-ray film. The grade of disc degeneration above the fractured vertebra was confirmed by evaluation of bony oedema in the fat suppressed sequences and T2-weighted image of magnetic resonance imaging. The degree of intervertebral disc degeneration was determined according to Pfirrmann classification. Results All patients in study group were followed up for （5.3±0.3）years, while the patients in control group were followed up for （5.8±0.2）years. In early fracture, the degree of intervertebral disc degeneration of the study group was grade Ⅰ in 26 cases, grade Ⅱ 9 cases, grade Ⅲ 2 cases, the rate of degeneration was 29.72%. In control group, the degree was grade Ⅰ in 29 cases, grade Ⅱ in 12 cases, grade Ⅲ in 1 case, the rate of degeneration was 30.95%. There was no significant difference in two group （χ^2 =0.014, P =0.763）. The degree at the last follow-up time was grade Ⅰ in 6 cases, grade Ⅱ 6 cases, grade Ⅲ 19 cases, grade Ⅳ 5 cases and grade Ⅴ in 1 case in study group, the rate of degeneration was 83.78% while in control group, grade Ⅰ 25 cases, grade Ⅱ 13 cases and grade m 4 cases. The rate of degeneration was 40.48%. There was statistically significant difference between two groups in the incidence of adjacent disc degeneration （χ^2 =15.474, P =0.003）. Conclusion The compression fracture of lumbar vertebrae may accelerate the degeneration of the discs adjacent to the fractured vertebral if the fractured vertebrace can not be well reduced.