腰椎退行性疾病手术病人术前邻近节段椎间盘的退变情况及分布规律

Degeneration and distribution of preoperative adjacent segment discs in patients with degenerative lumbar disease

目的观察腰椎退行性疾病手术病人术前邻近节段椎间盘的退变情况及分布规律。方法回顾性分析济南军区总医院2012年1月至2016年2月收治的503例行手术治疗腰椎退行性疾病病人的术前临床资料,其中男240例(47.71%),女263例(52.29%);年龄为20～84岁,平均48.8岁。腰椎间盘突出症352例,退变性腰椎滑脱症91例,退变性腰椎管狭窄症60例。通过术前X线片评估腰椎稳定性;基于术前MRI,采用Pfirrmann分级标准评价腰椎间盘退变程度,记录Modic改变、高信号区域及许莫氏结节的发生情况。结果 503例中仅5例为单节段退变,12例为跳跃节段退变,余486例均为多节段退变。共1 863个(1 863/2 515,74.08%)腰椎间盘发生退变,5个节段椎间盘(L_(1～2)、L_(2～3)、L_(3～4)、L_(4～5)、L_5～S_1)均退变的病人比例为39.56%(199例)。不稳定节段数为127个,Modic改变为188个,高信号区域为241个,许莫氏结节节段数为161个。30岁以下男性病人腰椎间盘退变率较女性高;随着年龄增长,女性病人椎间盘退变率增加,退变程度加重。腰椎不稳、Modic改变、高信号区和许莫氏结节均与椎间盘退变存在明显相关性(P均<0.05)。某一腰椎节段(L_(3～4)、L_(4～5)、L_5～S_1)椎间盘发生PfirrmannⅣ、Ⅴ级退变时,邻近节段椎间盘退变(PfirrmannⅢ+Ⅳ+Ⅴ级)比例均超过了80%,且严重退变(PfirrmannⅣ+Ⅴ级)比例也较高,超过60%。结论术前邻近节段椎间盘退变广泛存在,在临床工作中要予以重视。

Objective To observe the degeneration and distribution of adjacent segment discs of preoperative of patients with degenerative lumbar diseases. Methods The preoperative clinical data of 503 patients with degenerative lumbar diseases admitted to Jinan Military Region General Hospital from January 2012 to February 2016 were analyzed retrospectively, including 240 males （47.7%） and 263 females （52.3%） with an average age of 48.8 years. There were 352 cases of lumbar disc herniation, 91 cases of degenerative lumbar spondylolisthesis, and 60 cases of degenerative lumbar spinal stenosis. The stability of lumbar spine was assessed by preoperative X-ray, and the degree of lumbar disc degeneration was assessed by Pfirrmann grading criteria based on preoperative MRI. Modic changes, high-intensity zones and the occurrence of Schmorl＇s nodes were recorded. Results In 503 cases, there were 5 cases of single segment degeneration, 12 cases of jumping segment degeneration, and 486 cases of multilevel degeneration. 1 863 discs （1 863/2 515, 74.08%） in 503 cases underwent degeneration. 39.56% （199 cases） patients had disc degeneration of 5 segments （L1-2, L2-3, L3-4, L4-5, L5-S1）. There were 127 segments with instability, 188 Modic changes, 241 high-intensity zones, and 161 Schmorl＇s nodes. When the age is less than 30 years old, the incidence rate of lumbar intervertebral disc degeneration in male patients is higher than that in female patients. But with the increase of age, the incidence rate of intervertebral disc degeneration in female patients increased, and the degree of degeneration aggravated.Lumbar instability, Modic changes, high-intensity zones and Schmorl＇s nodes were all correlated with lumbar disc degeneration. When disc degeneration of lower lumbar segments （L3-4, L4-5 and L5-S1） occurred to Pfirrmann Ⅳ and Ⅴ, the proportion of adjacent segment disc degeneration （Pfirrmann Ⅲ＋Ⅳ＋Ⅴ） exceeded 80%, and the proportion of severe degeneration （Pfirrmann Ⅳ ＋ Ⅴ） in adjacent segments was also high, exceeding 60% .Conclusion Preoperative adjacent segment degeneration widely exist and should be attached importance in clinical work.