健康成人腰椎棘突偏歪的X线研究

A X-ray study of lumbar vertebral spinous process deviation in healthy adults

目的:探讨腰椎棘突偏歪与椎体旋转的关系。方法:收集100例健康成人的腰椎正位X线片。男58例,女42例;年龄22~51岁,中位数32岁;按Nash-Moe法评定,椎体旋转程度均为Neutral级。分析腰椎正位X线片上的棘突偏歪情况。结果:100例受检者的500椎腰椎中,444椎棘突无偏歪、56椎棘突偏歪。棘突偏歪的56椎中,棘突左偏25椎、棘突右偏31椎。L1棘突偏歪1椎(棘突右偏)、L2棘突偏歪12椎(棘突左偏9椎、棘突右偏3椎)、L3棘突偏歪10椎(棘突左偏6椎、棘突右偏4椎)、L4棘突偏歪17椎(棘突左偏5椎、棘突右偏12椎)、L5棘突偏歪16椎(棘突左偏5椎、棘突右偏11椎)。不同节段椎体棘突偏歪率比较,差异有统计学意义(χ~2=16.639,P=0.003);L1棘突偏歪率低于其余4个节段(χ~2=9.955,P=0.002;χ~2=7.792,P=0.005;χ~2=15.629,P=0.000;χ~2=14.465,P=0.000);其余4个节段椎体棘突偏歪率两两比较,组间差异均无统计学意义。不同节段椎体棘突偏歪方向比较,差异有统计学意义(P=0.049);不同节段椎体棘突偏歪方向两两比较,组间差异均无统计学意义。结论:健康成人的腰椎存在一定比例的棘突偏歪,临床上不能单纯以棘突偏歪作为腰椎有无旋转的诊断标准。

Objective：To explore the relationship between lumbar vertebral spinous process deviation and vertebral rotation.Methods：The anteroposterior X-ray films of lumbar vertebrae of 100 healthy adults were collected.The adults consisted of 58 males and 42 females and ranged in age from 22 to 51 years（Median=32 yrs）.All patient’s vertebral rotation belonged to neutral grade according to Nash-Moe evaluation standard.The spinous process deviation was analyzed on anteroposterior X-ray films of lumbar vertebrae.Results：Undeviated spinous processes（444 vertebraes）and deviated spinous processes（56 vertebraes）were found in 100 healthy adults（500 vertebraes）,and 25vertebraes deviated on the left side and 31 on the right side among the 56 vertebraes with deviated spinous processes.The deviations of spinous processes were found in 1（on the right）,12（9 on the left and 3 on the right）,10（6 on the left and 4 on the right）,17（5 on the left and 12 on the right）and 16（5 on the left and 11 on the right）vertebraes at L_1,L_2,L_3,L_4and L_5segment repectively.There was statistical difference in spinous process deviation rate between different vertebral segments（χ^2=16.639,P=0.003）.The spinous process deviation rate of L_1segment was lower than that of the other 4 vertebral segments（χ^2=9.955,P=0.002;χ^2=7.792,P=0.005;χ^2=15.629,P=0.000;χ^2=14.465,P=0.000）.Further pairwise comparison showed that there was no statistical difference in spinous process deviation rate between the other 4 vertebral segments.There was statistical difference in the direction of deviated spinous process between different vertebral segments（P=0.049）.Further pairwise comparison showed that there was no statistical difference in the direction of deviated spinous process between different vertebral segments.Conclusion：There is a certain proportion of lumbar spinous process deviation in healthy adults,so the spinous process deviation cann’t be used as the exclusive diagnostic criteria of lumbar rotation in clinic.