青少年下腰椎间盘突出症的病因分析———腰椎过度承载及腰骶部骨与关节形态变异在发病中的意义

Etiology of lumbar disc herniation in adolescents: excessive load on the lumbar spine and aberrant configurations of the lumbosacral region

中文关键词:  腰椎间盘突出症  儿童  青少年  髂腰韧带  髂嵴连线

英文关键词:Lumbar disc herniation  Children  Adolescents  Iliolumbar ligament  Intercrestal line

中文摘要:

  【摘要】 目的：对青少年下腰椎间盘突出症的病因进行分析，探讨腰骶部骨与关节结构形态变异在发病中的意义。方法：对我院骨科在2006年1月～2014年12月之间收治的76例连续的20岁以下青少年腰椎间盘突出症病例的病因进行回顾性分析。回顾所有患者的病史、统计患者的身高、体重及BMI并将其与文献中报道的同年龄组正常青少年的平均身高、体重及BMI进行比较。从所有病例中选出只累及L4/5或L5/S1的病例共63例，分别测量并比较两组患者腰骶结合部骨与关节结构形态，即腰椎正位X线片上髂嵴连线高度、L5横突长度及移行椎畸形情况，分析其与不同节段腰椎间盘突出症之间的关系。结果：本研究中所有患者的身高及体重均显著性地高于同年龄组正常青少年的平均值。髂嵴连线高度正常或过高（33例）、L5横突长度过长（44例）、无移行椎或有腰椎骶化畸形（44例）的患者发生L4/5间盘突出的几率分别为97.0%（32/33）、70.5%（31/44）和68.2%（30/44）；反之，髂嵴连线高度低（30例）、L5横突长度正常（19例）、有骶椎腰化畸形（19例）的患者出现L5/S1间盘突出的几率分别为86.7%（26/30）、73.7%（14/19）和68.4%（13/19）。结论：青少年腰椎间盘突出症与患者身高过高和/或体重超重有关；腰骶结合部的发育变异对下腰椎间盘突出症可能发生的节段有显著影响。

英文摘要:

  【Abstract】 Objectives: To analyze the causes of the lumbar intervertebral disc herniation in adolescents, and to investigate the significance of the morphological variation of bone and joint structure in the pathogenesis of disease. Methods: A total of 76 consecutive adolescents suffering from lumbar disc herniation and treated in a single medical institute during January 2006 to December 2014 were retrospectively studied. Patients′ onset of symptoms, body heights, weights and BMI were compared with those of the group with the same average age in the previous reports. Cases with single level disc herniation involving L4/5 or L5/S1 level were totally 63 and measured for lumbar spine configurations. Lumbar spine configurations included the height of intercrestal line, the length of L5 transverse processes and the presence of transitional vertebrae in anteroposterior radiographs, which were compared and analyzed for relationship with the level of disc herniation. Results: Both males and females in the study under 19 years old(61 cases) had significantly higher body height and greater weight in comparison with the group with the same average age in the previous reports. Patients with high or normal intercrestal lines(33 cases), long L5 transverse processes(44 cases) and with lumbar sacralization(44 cases) had significantly higher incidence of L4/5 disc herniation, 97.0%(32/33), 70.5%(31/44) and 68.2%(30/44) respectively; while low intercrestal lines(30 cases), normal L5 transverse processes(19 cases) and lumbarization(19 cases) were associated with L5/S1 disc herniation, 86.7%(26/30), 73.7%(14/19), and 68.4%(13/19) respectively. Conclusions: Lumbar disc herniation in children and adolescents is significantly associated with patients′ height, body weight, BMI and configurations of the lumbar spine.