腰椎间盘突出症与腰椎休门病及休门样改变影像学表现的相关性研究

A correlative study of imaging features between lumbar disc herniation and lumbar Scheuermann's disease as well as Scheuermann's signs

目的通过影像学观察探讨腰段椎间盘突出症(lumbar disc herniation,LDH)和腰椎休门病(lumbar Scheuermann’s disease,LSD)及休门样改变的内在联系以及LSD在LDH发病中的作用。方法将2011年3月至2014年3月,我院收治的75例LDH(T12/L1~L5/S1)患者(共计450个运动节段)作为研究对象,其中存在腰椎间盘突出的143个节段作为研究组(LDH组),无腰椎间盘突出的307个节段作为对照组(N组)。通过复习其CT、MRI和X线片,对比两组合并各种影像学休门样改变的比例及LSD的比例,进一步在LDH组内分别对比存在各种休门样改变的节段和无休门样改变节段合并腰椎间盘突出的比例。结果LDH组出现各种休门样改变的比例均高于N组,分别为Schmorl结节23.8%(34/143)和5.5%(17/307;χ~2=32.29,P<0.001),终板不规则55.9%(80/143)和4.2%(13/307;χ~2=159.10,P<0.001),椎体后缘离断27.3%(39/143)和0.3%(1/307;χ~2=87.47,P<0.001),椎体楔形变7.0%(10/143)和0.7%(2/307;χ~2=12.77,P<0.001)。LDH组34.26%(49/143)的节段符合腰椎休门病诊断,而N组仅为0.98%(3/307;χ~2=105.78,P<0.001)。存在Schmorl结节(66.7%,34/51;χ~2=82.61,P<0.001)、终板不规则(86.0%,80/93;χ~2=191.51,P<0.001)、椎体后缘离断(97.5%,39/40;χ~2=152.47,P<0.001)、椎体楔形变(83.3%,10/12;χ~2=41.05,P<0.001)的节段发生椎间盘突出的比例均高于无休门样改变的节段(12.2%,39/320)。结论 LDH与LSD关系密切,LSD可能参与LDH的发病。Schmorl结节、终板不规则、椎体楔形变以及椎体后缘离断,与腰椎间盘突出的发生有关。

Objective To investigate the relationship between lumbar disc herniation （ LDH ） and lumbar Scheuermann＇s disease （ LSD ） as well as Scheuermann＇s signs and the role of LSD in the etiology of LDH by imaging observation. Methods From March 2011 to March 2014, a total of 450 motion segments from 75 patients diagnosed with LDH （ T12 / L1 - L5 / S1 ） in our hospital were chosen as the research objects, among which 143 segments with LDH were selected as the experiment group （ LDH group ）, and the left 307 segments were treated as the control group （ N group ）. The incidences of Scheuermann＇s signs and LSD were examined based on the review of CT, MRI and X-ray films. Furthermore, in LDH group, the incidence of LDH within segments with Scheuermann＇s signs was compared to that within segments without Scheuermann＇s signs. Results The incidence of all Scheuermann＇s signs was higher in LDH group than that in N group. The incidence of Schmorl＇s node was 23.8% （ 34 / 143 ） to 5.5% （ 17 / 307;χ2 = 32.29, P 〈 0.001 ）, and the incidence of irregular endplate was 55.9% （ 80 / 143 ） to 4.2% （ 13 / 307; χ2 = 159.10, P 〈 0.001 ）. The incidence of posterior bony edge separation was 27.3% （ 39 / 143 ） to 0.3% （ 1 / 307; χ2 = 87.47, P 〈 0.001 ）, and the incidence of wedge-shaped vertebra was 7.0% （ 10 / 143 ） to 0.7% （ 2 / 307; χ2 = 12.77, P 〈 0.001 ）. The incidence of LSD in N group was only 0.98% （ 3 / 307; χ2 = 105.78, P 〈 0.001 ）, while 34.26% （ 49 / 143 ） segments in LDH group were associated with LSD. In LDH group, the incidence of LDH within segments with Scheuermann＇s signs （ Schmorl＇s node： 66.7%, 34/51; χ2 = 82.61, P 〈 0.001; irregular endplate： 86.0%, 80/93; χ2 = 191.51, P 〈 0.001; posterior bony edge separation： 97.5%, 39 / 40; χ2 = 152.47, P 〈 0.001; wedge-shaped vertebra： 83.3%, 10 / 12;χ2 = 41.05, P 〈 0.001 ） was all higher than that within segments without Scheuermann＇s signs （ 12.2%, 39 / 320 ）.Conclusions There is a close relationship between LDH and LSD, suggesting that LSD might be involved in the pathogenesis of LDH. Schmorl＇s node, irregular endplate, wedge-shaped vertebra and posterior bony edge separation are associated with LDH.