退变性腰椎侧凸两侧椎间高度及关节突矢状角参数特点及其对侧凸的影响

Feature of bony structural parameters and their effect on degenerative lumbar scoliosis

中文关键词:  骨性结构参数  椎间盘-终板  不对称退变  腰椎侧凸

英文关键词:Bony structural parameter  Intervertebral disc-endplate  Asymmetric degeneration  Lumbar scoliosis

中文摘要:

  【摘要】 目的：分析退变性腰椎侧凸骨性结构参数的特点及其与椎间盘-终板退变的相关性，探讨骨性结构参数对腰椎侧凸发生、发展的影响及意义。方法：选取120例原发性退变性腰椎侧凸患者的影像学资料作为病例组，同时期、同年龄段及同性别比例诊断为腰椎退变性疾病（除外腰椎侧凸）的89例患者的影像学资料作为对照组。分别测量两组患者椎体和椎间两侧高度及两侧关节突矢状角，计算椎体和两侧椎间平均高度及两侧关节突平均矢状角作为骨性结构参数。测量病例组患者的腰椎侧凸角及前凸角。采用pffirman及Modic分级评分法对各个椎间盘及邻近终板退变程度进行量化。比较两组的骨性结构参数，分析骨性结构参数与椎间盘-终板退变、腰椎侧凸角及前凸角的关系。结果：病例组凸凹侧骨性结构参数有显著性差异（P＜0.05），呈不对称分布；对照组两侧骨性结构参数无显著性差异（P＞0.05）；两组间椎间盘-终板退变评分有显著性差异（P＜0.05）。相关性分析显示，骨性结构参数不对称度与椎间盘-终板退变评分有相关性（P＜0.05），与腰椎侧凸角呈正相关（0＜r＜1，P＜0.05），与腰椎前凸角呈负相关（-1＜r＜0，P＜0.05）；回归分析显示，腰椎侧凸角及腰椎前凸角与骨性结构参数不对称度存在直线回归关系（F=431.671和17.137，P＜0.01）。结论：退变性腰椎侧凸椎间盘-终板退变较重，骨性结构参数呈不对称分布，其不对称度与椎间盘-终板不对称退变相关；腰椎侧凸角随骨性结构不对称的加重而进展，而前凸角度反而呈减小趋势。

英文摘要:

  【Abstract】 Objective：To investigate the relationship between intervertebral disc-endplate degeneration and bony structural parameterｓ and the effect of bony structural parameters on the development of degenerative lumbar scoliosis.Method：The imaging data of 120 patients with primary degenerative lumbar scoliosis in our hospital were retrospectively reviewed as case group，while 89 patients with lumbar degenerative disease and without lumbar scoliosis were selected as control group.The vertebral body and intervertebral height in both sides on frontal X-ray，and the facet joint orientation in both sides on CT scan were measured respectively.The average vertebral body height，average intervertebral disc height and average facet orientation were regarded as bony structural parameters.Lumbar scoliosis and lordosis Ｃobb′s angles of the case group were measured.The quantitative grading methods were used and the relationship between asymmetric bony structural parameters and intervertebral disc-endplate degeneration were analyzed through comparing bony structural parameters.Result：The bony structural parameters between convex and concave side of the case group showed significant difference（P＜0.05），which indicated asymmetric distribution of bony structural parameters in degenerative lumbar scoliosis，and the bony structural parameters between right and left side of the control group showed ｎｏ　significant difference（P＞0.05）.The degree of intervertebral disc-endplate degeneration between 2 groups showed significant difference（P＜0.05）.By correlation analysis，asymmetric degree of bony structural parameterｓ showed good correlation with degree of intervertebral disc-endplate degeneration（P＜0.05），which was positively correlated with lumbar scoliosis Ｃobb′s angle（0＜r＜1，P＜0.05），but negatively correlated with lumbar lordosis Ｃobb′s angle（-1＜r＜0，P＜0.05）.Linear regression existed between lumbar scoliosis angle as well as lordosis angle and asymmetric degree of bony structural parameterｓ（F=431.671　ａｎｄ　17.137，P＜0.01）.Conclusion：High degree of intervertebral disc-endplate degeneration is more often in degenerative lumbar scoliosis and bony structural parameters show asymmetric distribution which significantly correlate with asymmetric intervertebral disc-endplate degeneration.Lumbar scoliosis Ｃobb′s angle increaseｓ with progression of bony structural asymmetric degree，however lumbar lordosis Ｃobb′s angle decreaseｓ with ｉｔ.