青少年腰椎椎间盘突出症流行病学及危险因素分析

Epidemiology and Risk Factors of Lumbar Disc Herniation in Adolescents

目的 :对青少年腰椎椎间盘突出症进行流行病学调查并进行危险因素分析。方法 :本组观察对象为2014年8月～2017年8月于我院确诊的120例青少年(15～24岁)腰椎椎间盘突出症(adolescent lumbar disc herniation,ALDH)患者,以及年龄、性别体检中心100例体检正常人员,分别设为观察组与对照组。对120例ALDH患者进行流行病学调查,包括年龄分布、症状及体征、影像学表现等。调查两组患者性别、身体质量指数(Body Mass Index,BMI)、家族史等基本情况,单因素分析ALDH的危险因素,多因素logistic回归分析探寻ALDH的独立危险因素。结果 :120例ALDH患者男性86例,占比71.67%,女性34,占比28.33%;年龄分布中21～22岁最多,共44例,占比36.67%,15～16岁最少,共11例,占比9.17%;症状分布前三位分别为腰痛伴下肢放射痛(90例)、腰椎活动受限(82例)、下肢肌力下降(76例),分别占比75.00%、68.33%、63.33%;影像学分析结果显示单节段突出97例,占比80.83%,以L4/5突出为主,共54例,占比44.16%;双节段突出23例,占比19.17%,L4/5+L5/S突出为主,共20例,占比16.67%;单因素分析结果显示BMI、LDH家族史、腰背损伤史、运动量、工作学习姿势、腰部负重与剧烈运动为ALDH的危险因素;多因素logistic回归分析显示BMI≥25kg/m^2(OR=2.326,%95CI为1.221～8.897)、有腰背部损伤史(OR=2.765,%95CI为1.342～11.214)、B类工作姿势(OR=2.478,%95CI为1.121～10.576)是影响ALDH的独立危险因素。结论 :男性ALDH多于女性,以单节段突出为主,主要表现为腰痛伴下肢放射痛与腰椎活动受限,有腰背部损伤史、BMI≥25kg/m^2、B类工作姿势均会增大ALDH风险。

Objective Investigated the epidemiological of lumbar disc herniation in young patients and analyzed the risk factors. Methods Selected 120 cases of adolescents lumbar disc herniation(ALDH) patients(15 to 24 years old) in our hospital from August 2014 to August 2017 as observation group, and enrolled 100 healthy people of the same age and gender into control group. Made epidemiological survey of 120 patients with ALDH, including age distribution, symptoms and signs, imaging performance, etc. And investigated the gender, body mass index(BMI), family history and other basic conditions. Used single factor analysis for ALDH risk factors, and used multivariate logistic regression analysis to explored the independent risk factors of ALDH. Results Of the 120 patients with ALDH, 86 were males, accounting for 71.67%, and 34 were females, accounting for 28.33%; In the age distribution, the majority of people aged 21～22 years, 44 cases, accounting for 36.67%; 15～16-year-old accounted for the fewest, a total of 11 cases, accounting for 9.17%; The top three symptoms were low back pain accompanied by lower limb radiation pain(90 cases), limited lumbar motion(82 cases), lower limb muscle strength(76 cases), accounting for 75%, 68.33% and 63.33% respectively; Imaging analysis showed 97 cases of single segmental protrusion, accounting for 80.83%, mainly as L4/5 prominent, a total of 54 cases, accounting for 44.16%; And 23 cases double section prominent, accounting for 19.17%, mainly as L4/5+L5/S prominent, a total of 20 cases, accounting for 16.67%; The single factor analysis showed that the BMI, LDH family history, the history of back injury, the amount of exercise, the working learning posture, the waist load and the severe exercise were the risk factors of ALDH; Multivariate logistic regression analysis showed that BMI≥25 kg/m^2(OR=2.326, %95 CI was 1.221～8.897), a history of low back injury(OR=2.765, %95 CI was 1.342～11.214), class B working posture(OR=2.478, % 95 CI was 1.121～10.576) were an independent risk factors affecting ALDH; Conclusion There are more male suffering from ALDH than female, single segment protrusion is the main mode; The main manifestations were low back pain accompanied by lower limb radiation pain and limited lumbar spine motion; A back injury history, BMI ≥ 25 kg/m^2, B class work posture will increase the risk of ALDH.