腰痛患者椎间盘真空现象分析：298例患者的回顾性分析

Analysis of intervertebral vacuum phenomenon in patients with low back pain: a retrospective analysis of 298 patients

中文关键词:  腰痛  椎间盘真空现象  椎间盘退变  Modic改变  软骨下硬化

英文关键词:Low back pain  Intervertebral vacuum phenomenon  Intervertebral disc degeneration  Modic changes  Subchondral sclerosis

中文摘要:

  【摘要】 目的：探讨腰椎间盘真空现象在腰痛患者中的发生率，明确腰椎间盘真空现象与重度腰椎间盘退变、Modic改变及软骨下硬化症的相关性，并分析腰椎间盘真空现象的危险因素。方法：对扬州大学附属苏北人民医院脊柱外科2022年8月~2023年8月收治的腰痛患者进行回顾性分析，将纳入研究患者按有/无真空现象分组，进行相关性及危险因素分析。根据腰椎三维CT评估所有腰椎节段的椎间盘真空现象以及软骨下硬化症，根据腰椎MRI评估所有腰椎节段的椎间盘退变等级以及Modic改变。分类变量的组间比较采用卡方检验进行，连续型变量的组间比较采用独立样本t检验，采用Logistic回归分析进行危险因素分析以及确定椎间盘真空现象各影响因素的优势比（odds ratio，OR）及95%置信区间（95%CI），采用受试者操作特征曲线（receiver operating characteritics，ROC）进一步分析腰椎间盘真空现象与各影响因素的相关性。结果：共纳入腰痛患者298例，男103例，女195例，年龄62.34±8.76岁，腰椎间盘真空组118例，腰椎间盘非真空组180例，腰椎间盘真空现象、重度腰椎间盘退变、Modic改变以及软骨下硬化症的发生率分别为39.60%（n=118）、76.17%（n=227）、66.78%（n=199）和27.18%（n=81）。腰椎间盘真空现象与重度腰椎间盘退变（OR=8.960）、Modic改变（OR=5.086）及软骨下硬化症（OR=2.954）显著相关。年龄（OR=1.125，P＜0.001）、体重指数（OR=1.316，P＜0.001）及吸烟（OR=12.755，P=0.035）是腰椎间盘真空现象的危险因素。结论：在慢性腰痛人群中，腰椎间盘真空现象与重度腰椎间盘退变、Modic改变及软骨下硬化症存在显著相关性。年龄、体重指数及吸烟是腰椎间盘真空现象的危险因素。

英文摘要:

  【Abstract】 Objectives: To obtain the incidence rate of intervertebral vacuum phenomenon in patients with low back pain, to clarify the correlations between intervertebral vacuum phenomenon and severe lumbar disc degeneration, Modic changes and subchondral sclerosis, and to analyze the risk factors for intervertebral vacuum phenomenon. Methods: A retrospective analysis was conducted on the patients with low back pain treated in the Department of Spinal Surgery of Northern Jiangsu Province Hospital Affiliated to Yangzhou University from August 2022 to August 2023, and the included patients were divided into two groups of intervertebral vacuum phenomenon group and non-intervertebral vacuum phenomenon group for correlations and risk factors′ anlysis. Intervertebral vacuum phenomenon and subchondral sclerosis in all lumbar segments were evaluated according to three-dimensional CT images, lumbar disc degeneration grades and Modic changes were evaluated according to MRI. Chi-square test was used for categorical variables, independent t-test was used for continuous variables, logistic regression analysis was used for risk factor analysis, and odds ratio(OR) and 95% confidence interval(CI) of each influencing factor of intervertebral vacuum phenomenon were determined, receiver operating characteritics (ROC) curve was used to further demonstrate the correlations between the vacuum phenomenon and influencing factors. Results: A total of 298 patients with low back pain were enrolled, including 103 males and 195 females, aged 62.34±8.76 years old, and 118 cases were in the intervertebral vacuum phenomenon group and 180 cases in the non-intervertebral vacuum phenomenon group. The incidences of intervertebral vacuum phenomenon, severe lumbar disc degeneration, Modic changes and subchondral sclerosis were 39.60%(n=118), 76.17%(n=227), 66.78%(n=199), 27.18%(n=81), respectively. Intervertebral vacuum phenomenon was significantly related to severe lumbar intervertebral disc degeneration(OR=8.960), modic changes (OR=5.086) and subchondral sclerosis(OR=2.954). Age (OR=1.125, P<0.001), body mass index(BMI)(OR=1.316, P<0.001) and smoking (OR=12.755, P=0.035) were risk factors of intervertebral vacuum phenomenon. Conclusions: Intervertebral vacuum phenomenon is significantly associated with severe lumbar intervertebral disc degeneration, Modic changes and subchondral sclerosis in patients with chronic low back pain. In addition, age, BMI and smoking are risk factors for intervertebral vacuum phenomenon.