退行性腰椎管狭窄症患者下腰椎形态特征的研究

Clinical research of morphological characteristics of lower lumbar spine in patients with degenerative lumbar vertebral canal stenosis

目的探讨退行性腰椎管狭窄症患者下腰椎的形态特征。方法回顾性我科收治的40例退行性腰椎管狭窄患者,并抽取30例健康体检患者作为对照组,测量狭窄组患者病变节段及对照组L_(3-4)以下各节段椎体矢状径、椎体冠状径、椎管骨性矢状径、椎管软组织矢状径、侧隐窝矢状径、关节突角度、关节突退变等级,测量所有患者腰椎曲度,并进行统计学分析。结果腰椎管狭窄组L_(3-4)病变节段椎管软组织矢状径、关节突角度较正常明显减小,而关节突退变等级二者无明显差异;L_(4-5)病变节段椎体矢状径、冠状径、椎管软组织矢状径、侧隐窝矢状径及关节突角度较正常明显减小,同时二者关节突退变等级存在明显差异;L_5-S_1病变节段椎体矢状径、冠状径、侧隐窝矢状径及关节突角度较正常明显减小,二者关节突退变等级也存在明显差异;椎管狭窄组腰椎曲度明显小于对照组。结论造成L_(3-4)节段狭窄的原因可能是先天性关节突的矢状化改变,而造成L_(4-5)、L_5-S_1椎管狭窄的因素可能是先天性的"小"椎体及椎管周围组织的退行性改变。

Objective To investigate the morphological characteristic of lumbar spine in patients with degenerative lumbar vertebral canal stenosis. Methods From March 2014 to October 2016, 40 patients with degenerative lumbar vertebral canal stenosis were enrolled. Thirty patients with physical examination were enrolled as control group. Coronal and sagital distance of vertebral body, bony sagital distance of vertebral canal, soft tissue sagital distance of vertebral canal, sagital distance of lateral crypt, lumbar facet joint angle, the degree of degeneration of facet joints and lumbar radian were measured. Results Soft tissue sagital distance of vertebral canal and facet joint angle of L（3-4） lesion segment in patients with degenerative lumbar vertebral canal stenosis were less than those in control group, the differences were statistically significant（P〈0.05）. Coronal and sagital distance of vertebral body, soft tissue sagital distance of vertebral canal, sagital distance of lateral crypt and facet joint angle of L（4-5） lesion segment in patients with degenerative lumbar vertebral canal stenosis were less than those in the control group, the differences were statistically significant（P〈0.05）. The difference of the degree of degeneration of facet joints between the two groups was statistically significant（P〈0.05）. The results of the comparison between L5-S1 lesion segment in patients with degenerative lumbar vertebral canal stenosis and control group were nearly the same except soft tissue sagital distance of vertebral canal. Lumbar radian of patients with degenerative lumbar vertebral canal stenosis was less than control group, the difference was statistically significant（P〈0.05）. Conclusion At L（3-4） lesion segment, the cause of the vertebral canal stenosis is possibly the sagittal angle which is the pre-exsiting anatomical factor. However, at the L（4-5） and L5-S1 lesion segment, the causes are possibly the little vertebral body and the degenerative changes of the facet joint.