不同骨盆倾斜角与破裂型LDH髓核重吸收的相关性

CORRELATION OF PELVIC TILT WITH NUCLEUS PULPOSUS REABSORPTION IN RUPTURED LUMBAR DISC HERNIATION

目的探讨不同骨盆倾斜角(PT)与破裂型腰椎间盘突出(LDH)髓核重吸收的相关性。方法回顾性分析2010年5月—2019年3月在我院采用自然吸收法治疗65例破裂型LDH病人的临床资料。根据随访1年后病人椎间盘大小分为重吸收组35例和未重吸收组30例。检测并比较两组病人治疗前与随访1年后的脊柱-骨盆矢状位相关参数,比较两组影像学分型和不同PT病人髓核重吸收情况。采用Spearman相关性分析骨盆参数与髓核重吸收的关系。结果随访1年,重吸收组骶骨倾斜角(SS)、PT和腰椎前凸角(LL)与其治疗前以及未重吸收组治疗后比较,差异均有统计学意义(t=3.194~9.931,P<0.05);重吸收组SS、LL和PT治疗前后差值均高于未重吸收组(t=23.626~41.042,P<0.05)。重吸收组转归优于未重吸收组,差异有统计学意义(Z=-6.909,P<0.05)。脊柱-骨盆矢状面参数SS、LL均与髓核重吸收呈正相关(r=0.447、0.533,P<0.05),而PT与髓核重吸收呈负相关(r=-0.510,P<0.05)。结论破裂型LDH髓核重吸收病人转归较好,与其脊柱-骨盆矢状面参数LL、SS、PT变化存在显著相关性。脊柱-骨盆矢状面相关参数改变可能促进破裂型LDH髓核重吸收。

Objective To investigate the correlation of pelvic tilt(PT)with nucleus pulposus reabsorption in patients with ruptured lumbar disc herniation(LDH).Methods A retrospective analysis was performed for the clinical data of 65 patients with ruptured LDH who received natural absorption therapy in our hospital from May 2010 to March 2019,and according to the size of intervertebral disc after one year of follow-up,the patients were divided into reabsorption group with 35 patients and non-reabsorption group with 30 patients.The two groups were compared in terms of sagittal spinal-pelvic parameters before treatment and after 1 year of follow-up and imaging classification,and nucleus pulposus reabsorption was compared between the patients with different PTs.A Spearman correlation analysis was performed to investigate the correlation between pelvic parameters and nucleus pulposus reabsorption in patients with ruptured LDH.Results After 1-year follow-up,the reabsorption group had significant changes in sacral slope(SS),PT,and lumbar lordosis(LL),and there were significant differences between the reabsorption group and the non-reabsorption group in these parameters(t=3.194-9.931,P<0.05);compared with the non-reabsorption group,the reabsorption group had significantly greater changes in SS,LL,and PT after treatment(t=23.626-41.042,P<0.05).The reabsorption group had a significantly better clinical outcome than the non-reabsorption group(Z=-6.909,P<0.05).The sagittal spinal-pelvic parameters SS and LL were positively correlated with nucleus pulposus reabsorption(r=0.447,0.533;P<0.05),and PT was negatively correlated with nucleus pulposus reabsorption(r=-0.510,P<0.05).Conclusion Ruptured LDH patients with nucleus pulposus reabsorption tend to have a good outcome,which is significantly correlated with changes in the sagittal spinal-pelvic parameters LL,SS,and PT.Moreover,the changes in sagittal spinal-pelvic parameters may promote nucleus pulposus reabsorption in patients with ruptured LDH.