腰椎间盘突出症患者下腰椎终板矢状面形态特征

Lumbar vertebral endplate sagittal morphology of patients with lumbar disc herniation

中文关键词:  腰椎间盘突出症  终板  终板形态  腰椎退行性改变

英文关键词:Lumbar disc herniation  Endplate  Endplate morphology  Lumbar degeneration

中文摘要:

  【摘要】 目的：观察腰椎间盘突出症（lumbar disc herniation，LDH）患者下腰椎（L3~S1）终板矢状面形态特征。方法：回顾性分析2016年6月~2017年7月就诊我院的腰椎间盘突出症患者和无明确腰椎疾病的志愿者。共纳入LDH患者141例，其中男61例，女80例，年龄61.6±10.1岁（41~79岁），身体质量指数（BMI）为26.3±3.4（18.3~33.2）。对照组纳入志愿者109例，其中男47名，女62名，年龄55.4±12.2岁（40~87岁）， BMI为25.3±3.6（17.6~32.5）。在腰椎CT正中矢状面重建图像上测量LDH患者椎间盘突出节段的终板形态和志愿者腰椎L3下终板至S1上终板的终板形态学参数，包括终板屈曲深度（ECD）、矢状面屈曲角（SCA）和终板屈曲顶点位置（ECA）；相应节段椎间盘退变程度在MRI上通过Pfirrmann分级进行评估。应用t检验比较LDH组与对照组终板矢状面形态学参数；选择L4/5和L5/S1两节段中相同退变程度（Pfirrmann Ⅲ级，Pfirrmann Ⅳ级）的椎间盘，比较LDH组患者和对照组志愿者的终板矢状面形态。将LDH组患者和对照组志愿者终板数据合并后按照椎间盘退变程度分组（Pfirrmann Ⅱ级~Pfirrmann Ⅴ级），应用Kruskal-Wallis检验比较不同退变程度椎间盘终板形态参数的组间差异。结果：LDH组各节段终板ECD均显著低于对照组（L4上终板P=0.016，其余终板P<0.01），SCA均显著大于对照组（P<0.01）；除L3下终板外（P=0.014），所有节段终板ECA的组间差异无统计学意义（P>0.05）。L4/5和L5/S1节段中Pfirrmann Ⅲ级和Ⅳ级椎间盘终板，相同节段和退变分级的组间比较结果显示，LDH组终板ECD显著小于对照组（P<0.05），SCA显著大于对照组（P<0.05），ECA未出现组间显著性差异（P>0.05）。不同退变程度椎间盘终板形态参数组间比较显示，随着椎间盘退变进展，各节段ECD降低（P<0.01），SCA增大（P<0.01），ECA未出现一致的组间变化趋势。结论：LDH患者相比对照组志愿者，其下腰椎终板矢状面屈曲程度较低，退变程度较高的椎间盘其终板屈曲程度较小。

英文摘要:

  【Abstract】 Objectives: To investigate the lower lumbar spine(L3-S1) sagittal endplate morphology of lumbar disc herniation(LDH) patients. Methods: A retrospective analysis was performed on patients with lumbar disc herniation and volunteers treated in our hospital from June 2016 to July 2017. A total of 141 patients with LDH were enrolled, including 61 males and 80 females, with an average age of 61.6±10.1(41-79) years and an average BMI of 26.3±3.4(18.3-33.2). The control group included 109 volunteers, including 47 males and 62 females, with an average age of 55.4±12.2(40-87) years and an average BMI of 25.3±3.6(17.6-32.5). Endplate morphological parameters from L3 inferior endplate to S1 superior endplate in LDH patients and control volunteers were measured on mid-sagittal CT reconstruction. Morphology parameters included endplate concavity depth(ECD), sagittal concavity angle(SCA) and endplate concavity apex(ECA). Degeneration of intervertebral discs were evaluated by using Pfirrmann classification on MRI image. Endplates of volunteers were used as control. The t-test was used to compare the sagittal endplate morphological parameters between the LDH group and the control group. Endplate morphology parameters of both LDH patients and control volunteers were grouped according to the degree of disc degeneration(Pfirrmann Ⅱ to Pfirrmann Ⅴ). Kruskal-Wallis test was used to compare the endplate morphology among different groups. Results: The ECD of each segment of LDH group was significantly lower than that of the control group(P=0.016 at L4 superior endplate; P<0.01 at the remaining endplates). The endplate SCA of each segment of LDH group was significantly greater than that of the control group(P<0.01). There were no statistically significant differences of ECA in all segmental endplates except for the L3 inferior endplate(P=0.014). Comparison of Pfirrmann Ⅲ and Ⅳ discs in the L4/5 and L5/S1 segments showed that the ECD of endplates in LDH group was significantly smaller than that of the control group(P<0.05) and there was no significant difference between the groups in the ECA(P>0.05). The results of Kruskal-Wallis test showed that with the progression of intervertebral disc degeneration, the ECD of each segment decreased(P<0.01), the SCA increased(P<0.01), and ECA showed no consistent trend between groups. Conclusions: The results of the present study show that endplates of LDH patients are less concaved compared to those of the controls. Lower degree of endplate concavity corresponds to high degree of intervertebral disc degeneration.