凉山彝族自治州雷波县教师群体颈、腰椎退行性改变程度的放射研究

Radiological study on degree of cervical and lumbar degeneration of teachers in Leibo County of Liangshan Yi Autonomous Prefecture

目的了解凉山彝族自治州雷波县教师群体颈、腰椎退变程度。方法2019年10月招募符合标准的雷波县在职初、高中教师,进行职业健康检查。使用量化评分表进行颈、腰部主观不适感觉评分;通过颈、腰椎正侧位及过伸过屈位X光检查,记录医师主观判读及基于仪器测量的多项客观指标数据,了解颈、腰椎生理曲度、活动度及稳定性情况,并对数据进行分析。结果共招募96位教师,颈、腰主观评分为9.53±1.57和7.23±1.25。43位教师出现颈椎椎体不稳,以矢状位相邻椎体"阶梯样"改变为主。83位教师出现腰椎椎体不稳,以冠状位椎体"旋转"为主。仪器测量:颈椎平均弦弧距为(6.52±3.18)mm,86位教师存在颈椎生理曲度变直、反向;活动度为(62.68±11.56)°,显著降低;在标准侧位下,颈椎存在过屈趋势。腰椎前凸指数为(18.71±6.51)mm,48位教师曲度变直、31位教师曲度增大;活动度为(41.37±10.46)°,明显降低;在标准侧位下,腰椎存在过伸趋势。颈、腰椎主观评分与身高呈弱相关(P<0.05),与年龄、体重等基本信息及各项客观指标间不相关(均P>0.05)。年龄与颈椎弦弧距、腰椎前凸指数分别呈中等相关及弱相关(均P<0.05)。腰椎侧位联线夹角每增加1°,颈椎活动度减少0.997°。颈椎侧位联线夹角每增加1°,腰椎过伸位联线夹角增加1.004°。结论雷波县教师群体颈、腰椎退变已进入"骨错缝"关键性病理阶段,不正确的坐立行走姿势是主要原因,长期伏案工作同步推进颈、腰椎退变,站立授课以影响腰椎为主,并存在颈、腰椎退变相互影响,需引起重视。教师主观评分轻,放射检查结果偏重,考虑与长期固定体位的自身适应相关。

Objective To investigate the degree of cervical and lumbar degenerative changes among teachers in Leibo County of Liangshan Yi Autonomous Prefecture.Methods The junior and senior high school teachers of Leibo County,who meet the standard,were recruited for the occupational health examination in October,2019.The subjective discomfort scores of neck and waist were scored by using the quantitative scoring table.The results of subjective interpretation and objective data based on instrument measurement were recorded by X-ray examination of the positive and lateral position of the neck and lumbar spine and hyperextension and hyperflexion position to understand the physiological curvature,activity and stability of the neck and lumbar spine.Results Totally 96 teachers were recruited.The subjective scores of neck and waist were 9.53±1.57 and 7.23±1.25 respectively.There were 43 cases of instability of cervical vertebrae,mainly with the"ladder like"change of adjacent vertebrae in sagittal position.There were 83 cases of vertebral instability in the lumbar spine,mainly with coronal vertebral"rotation".Instrument measurement:the average chord arc distance of the cervical spine was(6.52±3.18)mm,86 teachers had the physiological curvature of the cervical spine becoming straight and reverse,the activity degree was(62.68±11.56)°,which significantly reduced,and the cervical spine had the tendency of over flexion under the standard lateral position.The lumbar lordosis index was(18.71±6.51)mm,there were 48 cases of curvature becoming straight and 31 cases of increased curvature,the mobility was(41.37±10.46)°,which significantly decreased,and the lumbar hyperextension trend existed under the standard lateral position.The subjective scores of neck and lumbar vertebrae were weakly correlated with height(P<0.05),and there were no correlations between the age,weight and other basic information and objective indicators(P>0.05).There were moderate correlation and weak correlation between age and cervical chord arc distance,lumbar lordosis index(all P<0.05).For every 1°increase in the angle between the lateral alignment of the lumbar spine,the cervical spine mobility decreased by 0.997°.For every 1°increase in the angle between the lateral positions of the cervical spine,the angle between the hyperextension positions of the lumbar spine increased by 1.004°.Conclusion The degeneration of neck and lumbar vertebrae of teachers in Leibo County has entered the key pathological stage of"instability of facet joint",and the main reason is incorrect sitting and walking posture.Long term bending over a table promotes the degeneration of neck and lumbar vertebrae synchronously.Standing teaching mainly affects the lumbar vertebrae.And there is the interaction of cervical and lumbar degeneration,which needs to be paid attention to.The subjective score is light while the result of radiology is heavy,which was related to the self-adaptation of long-term fixed body position.