退变性腰椎不稳患者腰椎MRI矢状位、轴位参数测量的临床价值

Clinical Value of Sagittal and Axial MRI Parameters Measurement in Patients with Degenerative Lumbar Instability

目的探讨退变性腰椎不稳患者进行腰椎MRI矢状位、轴位参数测量的价值,为提高影像诊断质量提供依据。方法选择某院骨科2019年1月31日-2020年8月31日收治的疑诊为退变性腰椎不稳患者150例,不稳组82例,稳定组68例,所有患者均接受腰椎过伸、过屈侧位DR摄片检查和腰椎MRI扫描,如患者矢状面移位>4mm,或成角>10°则列为不稳组,不能满足上述条件的患者列为稳定组。比较稳定组和不稳组腰骶角、黄韧带厚度、小关节积液厚度、腰椎间盘退变分级和小关节退变分级,分析腰椎不稳与上述参数的相关性。结果不稳组腰骶角、小关节积液厚度大于稳定组(P<0.01),腰椎间盘退变分级较稳定组严重(P<0.05),而小关节退变分级情况轻于稳定组(P<0.05),差异均有统计学意义。相关性分析显示腰椎不稳与腰骶角大小(r=0.176,P<0.05)、小关节积液厚度(r=0.291,P<0.05)、腰椎间盘退变分级(r=0.272,P<0.05)均呈正相关,与小关节退变分级呈负相关(r=-0.657,P<0.05)。结论退变性腰椎不稳与腰椎间盘退变程度、腰骶角、小关节积液量呈正相关,与小关节退变程度呈负相关,腰椎MRI矢状位、轴位测量上述参数对于退变性腰椎不稳具有重要的参考价值。

Objectives To investigate the value of sagittal and axial measurement of lumbar MRI in patients with degenerative lumbar instability.Methods 150 patients with suspected degenerative lumbar instability admitted to our hospital from January 31 st,2019 to August 31 st,2020 were selected.All patients were examined lumbar hyperextension and hyperflexion lateral DR radiography and lumbar MRI scanning.If the sagittal displacement>4 mm,or the angle>10°the patients were selected as the unstable group,and the patients who could not meet the above conditions were listed as the stable group.The lumbosacral angle,ligamentum flavum thickness,facet joint effusion thickness,lumbar disc degeneration grade and facet joint degeneration grade were compared between the stable group and the unstable group,and the correlation between lumbar instability and the above parameters was analyzed.Results There were 82 cases in unstable group and 68 cases in stable group.The thickness of lumbosacral angle and facet joint effusion of the unstable group was larger than that of the stable group(P<0.01).The degeneration grade of lumbar intervertebral disc of the unstable group was more serious than that of the stable group(P<0.05),but the degeneration grade of facet joint of the unstable group was lighter than that of the stable group(P<0.05).Correlation analysis showed that lumbar instability was positively correlated with the size of lumbosacral angle(r=0.176,P<0.05),the thickness of facet joint effusion(r=0.291,P<0.05),and the grade of lumbar disc degeneration(r=0.272,P<0.05),but negatively correlated with the grade of facet joint degeneration(r=-0.657,P<0.05).Conclusions Degenerative lumbar instability was positively correlated with the degenerative degree of lumbar intervertebral disc,lumbosacral angle and the amount of effusion in facet joints,but negatively correlated with the degree of facet joint degeneration.The above parameters measured by sagittal and axial MRI of lumbar spine had important reference value for degenerative lumbar instability.