腰椎间盘突出症患者突出椎间盘及相邻椎间盘退变程度的MRI分析

Analysis of MRI on the degeneration degree of herniated disc and adjacent disc in lumbar disc herniation

中文关键词:  腰椎间盘突出症  相邻椎间盘  MRI

英文关键词:Lumber disc herniation  Adjacent disc  MRI

中文摘要:

  【摘要】 目的：分析腰椎间盘突出症患者突出椎间盘及相邻椎间盘的术前MRI表现，评估其退变程度。方法：回顾性分析2014年6月~2015年12月在宁夏医科大学总医院脊柱骨科已行手术治疗的的单节段腰椎间盘突出症患者100例，其中男56例，女44例，年龄23~79岁（51.68±5.60岁），将所有患者以10年为一年龄段进行分组。突出椎间盘发生在L4/5节段50个，其相邻椎间盘100个；L5/S1节段50个，其相邻椎间盘50个。观察术前腰椎MRI，椎间盘采用Pfirrmann分级标准进行评估；软骨终板形态以Pappou分级标准进行评估。年龄段间的比较采用单因素方差分析，相邻椎间盘与退变椎间盘间的相关性采用Pearson相关分析，相邻椎间盘间的比较采用t检验。结果：各年龄段L4/5、L5/S1突出椎间盘的Pfirrmann分级均在Ⅲ级以上、Pappou分级均在Ⅱ级以上，各年龄段间椎间盘退变结果有统计学差异（P<0.05）；而各年龄段间软骨终板退变结果无统计学差异（P>0.05）。各年龄段间突出椎间盘发生在L4/5、L5/S1的上位相邻椎间盘Pfirrmann分级有统计学差异（P<0.05），下位相邻椎间盘Pfirrmann分级各年龄段无统计学差异（P>0.05），相邻椎间盘软骨终板退变结果各年龄段间无统计学差异（P>0.05）。相邻的L3/4椎间盘Pfirrmann分级与突出的L4/5椎间盘Pfirrmann分级有相关性（r=0.696，P=0.000），相邻L5/S1椎间盘Pfirrmann分级与突出L4/5椎间盘Pfirrmann分级间无相关性（r=0.214，P=0.136）；相邻的L3/4、L5/S1椎间盘软骨终板形态Pappou分级与突出的L4/5椎间盘软骨终板形态Pappou分级均有相关性（r=0.467，P=0.001；r=0.380，P=0.007）。相邻L4/5椎间盘的Pfirrmann分级与突出L5/S1椎间盘的Pfirrmann分级有相关性（r=0.549，P=0.000）；相邻L4/5椎间盘软骨终板形态Pappou分级与突出L5/S1椎间盘的软骨终板形态Pappou分级有相关性（r=0.684，P=0.001）。L4/5椎间盘突出的相邻L3/4椎间盘Pfirrmann分级和软骨终板形态Pappou分级评分分别为3.26±0.87分、1.54±0.50分，均高于相邻L5/S1椎间盘的2.96±0.59分、1.23±0.49分（P<0.05）。结论：腰椎间盘突出症患者突出节段的相邻椎间盘及软骨终板的退变与年龄及突出椎间盘退变程度关系密切，且相邻上位椎间盘较下位椎间盘退变更明显。

英文摘要:

  【Abstract】 Objectives: To analyze the MRI profile of protruding and its adjacent discs in lumbar disc herniation before surgery as well as the degree of degeneration, and to summarize their imaging features. Methods: 100 patients(56 males and 44 females, the rang of age was 23-79 and mean age was 51.68±5.60 years old) treated in spine surgery department of General Hospital of Ningxia Medical University from June 2014 to December 2015 were reviewed retrospectively. All patients were grouped into each age group for 10 years. There were 50 cases with L4/5 disc herniation of 100 adjacent discs, 50 cases with L5/S1 herniation of 50 adjacent discs. Pfirrmann Grading Standard was used for disc evaluation, and Pappou Grading Standard was used for evaluation of endplates from the preoperative MRI. Pearson correlation analysis was used to compare the correlation between adjacent disc and degenerative disc by using t-test. Results: In each range of age group, the Pfirrmann grade in segments herniated disc of L4/5, L5/S1 was over grade Ⅲ, and the Pappou grade was over grade Ⅱ, age appeared statistically significant(P<0.05) among all groups, cartilage endplate degeneration among all age groups was not statistically significant(P>0.05). Upper adjacent disc Pfirrmann grade of herniated disc occurred at L4/5 and L5/S1, all ages were statistically significant(P<0.05), lower adjacent disc was not statistically significant(P>0.05), adjacent endplate cartilage degeneration result for each age group was not statistically significant(P>0.05). Correlation existed in the Pfirrmann grade of adjacent disc L3/4 and herniated disc L4/5(r=0.696, P=0.000), while no correlation was noted between adjacent disc L5/S1 and herniated disc L4/5(r=0.214, P=0.136), adjacent disc L3/4, L5/S1 and herniated disc L4/5 endplate morphology Pappou grade was correlated(r=0.467, P=0.001; r=0.380, P=0.007). Adjacent disc L4/5 and herniated disc L5/S1 Pfirrmann grade was correlated(r=0.549, P=0.000); there was correlation in the adjacent disc L4/5 and herniated disc L5/S1 endplate cartilage morphology Pappou grade(r=0.684, P=0.001). Adjacent disc L3/4 Pfirrmann grade and cartilage endplate morphology Pappou grade scores were 3.26±0.87 and 1.54±0.50 respectively, which were higher than the adjacent disc L5/S1 of 2.96±0.59 and 1.23±0.49(P<0.05). Conclusions: There are correlations among adjacent disc, endplate, age and disc degeneration in patients, the upper adjacent disc degeneration changes significantly than the lower.