成人退变性腰椎侧凸可矫正程度与侧凸节段椎间盘退变程度的相关性分析

A correlation analysis of the relationship between corrigible degree of degenerative lumbar scoliosis and degeneration degree of intervertebral disc at scoliosis segments in adults

目的:探讨成人退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)可矫正程度与侧凸节段椎间盘退变程度的相关性。方法:以2014年6月至2017年12月收治的成人DLS患者为研究对象。在患者术前拍摄的站立位全脊柱正位X线片、侧屈位X线片及胸腰椎MRI上评定主弯区域的椎间盘退变程度和可矫正程度。评定范围包括主弯区域侧凸顶部节段(apical vertebrae,AV),侧凸顶部上、下一节段(AV+1、AV-1),侧凸顶部椎间盘上、下两节段(AV+2、AV-2)。分别在站立位全脊柱正位X线片和侧屈位X线片上测量主弯Cobb角和椎间角,并以此计算脊柱柔韧性,间接评估侧凸可矫正程度。根据患者的MRI评价主弯区椎间盘的退变程度,依据Pfirrmann椎间盘退变分级标准进行分级,并按照等级进行评分(Ⅰ级为0分,Ⅱ级为1分,Ⅲ级为2分,Ⅳ级为3分,Ⅴ级为4分)。结果:研究共纳入33例患者,男10例,女23例;年龄55～72岁,中位数64岁。患者的站立位全脊柱正位X线片上的主弯Cobb角为30.4°±6.4°,侧屈位X线片上的主弯Cobb角为18.5°±5.1°,主弯整体柔韧性为(39.20±9.30)%。主弯各节段的椎间盘退变程度评分比较,差异有统计学意义[AV+2:(2.10±0.62)分,AV+1:(3.01±0.59)分,AV:(4.11±0.69)分,AV-1:(3.14±0.81)分,AV-2:(2.90±0.71)分,F=8.118,P=0.010];AV节段椎间盘退变程度评分高于其他节段(P=0.001;P=0.012;P=0.001;P=0.017)。主弯各节段的柔韧性比较,差异有统计学意义[AV+2:(56.08±13.52)%,AV+1:(40.61±10.63)%,AV:(30.30±8.22)%,AV-1:(45.11±11.17)%,AV-2:(60.08±12.10)%,F=9.104,P=0.007];AV节段的柔韧性低于其他节段(P=0.001;P=0.000;P=0.000;P=0.001)。主弯各节段的椎间盘退变评分与对应节段的柔韧性均呈负相关(AV+2:r=-0.713,P=0.001;AV+1:r=-0.623,P=0.000;AV:r=-0.899,P=0.000;AV-1:r=-0.683,P=0.001;AV-2:r=-0.603,P=0.002)。结论:成人DLS患者主弯各节段的椎间盘均存在不同程度的退行性改变,侧凸顶部椎间盘退变程度最高、可矫正程度最差,侧凸各节段的可矫正程度与相应节段的椎间盘退变程度均呈负相关。

Objective:To explore the correlation between corrigible degree of degenerative lumbar scoliosis(DLS)and degeneration degree of intervertebral disc at scoliosis segments in adults.Methods:The adults with DLS recruited from June 2014 to December 2017 were selected as the subjects.The degeneration degree of intervertebral disc and corrigible degree of DLS of main bending section were evaluated using the whole spine anteroposterior X-ray films in standing position and lateral flexion position and thoracic-lumbar MRI that were taken before surgery.The evaluation scopes covered apical vertebrae(AV),AV+1,AV-1,AV+2 and AV-2 of main bending section.The Cobb angle and intervertebral angle of the main bending section were measured on the whole spine anteroposterior X-ray films in standing position and lateral flexion position respectively,and the spinal flexibility was evaluated according to the final measurement results,and the corrigible degree of scoliosis was assessed indirectly.The degeneration degree of intervertebral disc of main bending section was evaluated and classified according to patients’MRI and Pfirrmann grading standards for intervertebral disc degeneration respectively,and it was scored according to the grade(0 point for gradeⅠ,1 point for gradeⅡ,2 points for gradeⅢ,3 points for gradeⅣand 4 points for gradeⅤ). Results: Thirty-three patients(10 males and 23 females)between the ages of 55 and 72(Median=64 yrs)were included in the study.The Cobb angles of the main bending section on the whole spine anteroposterior X-ray films in standing position and lateral flexion position were 30.4+/-6.4 and 18.5+/-5.1 degrees respectively,and the general flexibility of the main bending section was 39.20+/-9.30%.There was statistical difference in the scores of degeneration degree of intervertebral disc between segments of main bending section(AV+2: 2.10+/-0.62 points,AV+1:3.01+/-0.59 points,AV:4.11+/-0.69 points,AV-1:3.14+/-0.81 points,AV-2:2.90+/-0.71 points, F=8.118,P =0.010).The scores of degeneration degree of intervertebral disc were higher in AV segment compared to other segments( P=0.001;P=0.012;P=0.001;P =0.017).There was statistical difference in flexibility between segments of main bending section(AV+2:56.08+/-13.52%,AV+1:40.61+/-10.63%,AV:30.30+/-8.22%,AV-1:45.11+/-11.17%,AV-2:60.08+/-12.10%, F=9.104,P =0.007).The flexibility was poorer in AV segment compared to other segments( P=0.001;P=0.000;P=0.000;P= 0.001).The scores of of degeneration degree of intervertebral disc were negatively correlated with the flexibility in each segment of main bending section(AV+2: r=-0.713,P= 0.001;AV+1: r=-0.623,P =0.000;AV: r=-0.899,P =0.000;AV-1: r=-0.683 ,P =0.001;AV-2: r=-0.603,P =0.002).Conclusion:The degenerative changes of intervertebral disc at different degrees exist at each segment of main bending section in adults with DLS.The degeneration degree of intervertebral disc is highest and the corrigible degree is the lowest in AV segment.The corrigible degree is negatively correlated with degeneration degree of intervertebral disc in each segment of DLS.