腰椎间盘突出症不同证型腰椎小关节影像学特点及其与证候评分间的相关性研究

Study on Imaging Characteristics of Lumbar Facet Joints in Different Syndrome Types of Lumbar Disc Herniation and Its Correlation with Syndrome Score

目的:探讨腰椎间盘突出症不同证型腰椎小关节影像学特点,并分析其与证候评分间的相关性。方法:共纳入265例L3/4和(或)L4/5和(或)L5S1腰椎间盘突出患者,并依据中医诊断标准分为肝肾亏虚组(129例)和气滞血瘀组(136例),评估两组患者腰椎小关节退变程度、腰椎小关节角度及腰椎小关节对称性等影像学参数的各自特征;用证候评分量表量化两组患者中医证候的严重程度,分析腰椎小关节上述影像学指标与证候评分间的相关性。结果:两组患者腰椎小关节有不同的影像学特征,肝肾亏虚组患者与气滞血瘀组相比,腰椎小关节退变程度更高(P<0.05),腰椎小关节角度趋于矢状化,差异有统计学意义(P<0.05),不对称性更强,差异有统计学意义(P<0.05);此外肝肾亏虚组证候评分与腰椎小关节退变程度呈显著的正相关,差异有统计学意义(P<0.05);腰椎小关节角度及不对称性与证候评分间无明显相关性。结论:不同证型的腰椎间盘突出症患者具有不同的腰椎小关节影像学特点,腰椎小关节退变程度也可以反映肝肾亏虚型腰椎间盘突出症患者中医证候程度。

Objective:To explore the radiological characteristics of lumbar facet joints(LFJ)in different patterns of lumbar disc herniation(LDH)and analyze their correlation with traditional Chinese medicine(TCM)syndrome scores.Methods:265patients with LDH involving the L3/4and(or)L4/5and(or)L5S1segments were included in this study.Patients were divided into two groups based on TCM diagnostic criteria:the liver-kidney deficiency group(129cases)and the Qistagnation and blood stasis group(136cases).Radiological parameters,including the degree of LFJ degeneration,LFJ angle,and LFJ orientation,were evaluated to determine their characteristics in each group.TCM syndrome severity was quantified using a syndrome score scale,and the correlation between the radiological parameters of the LFJ and syndrome scores was analyzed.Results:The results showed that the LFJ exhibited different radiological features between the two groups.Compared to the Qi-stagnation and blood stasis group,the liver-kidney deficiency group had a higher degree of LFJ degeneration(P<0.05),a tendency towards a more sagittal orientation of the LFJ angle(P<0.05),and stronger asymmetry(P<0.05).Furthermore,there was a significant positive correlation between the syndrome scores of the liverkidney deficiency group and the degree of LFJ degeneration(P<0.05).However,there was no significant correlation observed between the LFJ angle,asymmetry,and syndrome scores.Conclusion:With different patterns of LDH exhibit distinct radiological characteristics of the LFJ.The degree of LFJ degeneration can also reflect the severity of TCM syndrome in patients with liver-kidney deficiency type LDH.