绝经后女性骨密度与腰椎间盘退变的相关性分析

Correlation between bone density and lumbar disc degeneration in postmenopausal women

中文关键词:  椎间盘退变  骨密度  绝经  女性

英文关键词:Disc degeneration  Bone mineral density  Menopause  Women

中文摘要:

  【摘要】 目的：观察绝经后女性腰椎和髋部骨密度与腰椎间盘退变的关系。方法：回顾性统计2017年12月~2018年12月因腰痛在我院脊柱外科门诊及住院的229例绝经后女性患者，记录患者年龄、身高、体重、糖尿病史、高血压病史、饮酒史、吸烟史等，采用双能Ｘ线骨密度测量仪检查患者腰椎椎体（L1~L4）骨密度和髋部平均骨密度，记录相应的T值，每例患者同时行腰椎MRI检查。根据骨密度T值≥-1.0为正常，-2.5＜T值＜-1.0为骨量减少，T值≤-2.5诊断为骨质疏松，将患者分为骨质疏松组（n=78）、骨量减少组（n=73）和正常组（n=78）。每个节段腰椎间盘退变程度用Pfirrmann分级系统进行评分，用协方差和Spearman相关性分析来分析腰椎和髋部骨密度与腰椎间盘退变的关系。结果：骨质疏松组、骨量减少组和骨量正常组的年龄分别为67.17±9.99岁、65.66±10.71岁、55.29±12.35岁，骨质疏松组、骨量减少组年龄显著大于骨量正常组（P＜0.05）；骨质疏松组的体重指数小于正常组（23.38±2.37kg/m2 vs 24.72±2.96kg/m2，P＜0.05）；其余一般资料各组间无显著性差异（P>0.05）。上腰椎（L1、L2）中，骨质疏松组腰椎间盘退变评分均较正常组低（2.24±0.82 vs 2.60±0.95，2.79±0.95 vs 3.18±0.94，P＜0.05），而与骨量减少组比较无显著性差异（P>0.05）；下腰椎（L3、L4）椎体和髋部不同骨密度组之间椎间盘退变程度无显著性差异（P>0.05）。各腰椎椎体骨密度分别与腰椎间盘平均退变程度呈正性相关（L1：r=0.185；L2：r=0.157；L3：r=0.180；L4：r=0.132；L1~L4：r=0.180；均P＜0.05），髋部骨密度与腰椎间盘退变的严重程度无统计学相关性。结论：绝经后女性腰椎间盘退变的严重程度与腰椎骨密度存在正相关关系，提示绝经后女性腰椎骨密度较高者椎间盘退变可能更严重，有必要进一步做腰椎CT或者MRI检查；股骨颈骨密度检查对骨质疏松诊断更有帮助。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between bone mineral density(BMD) and lumbar disc degeneration in postmenopausal women. Methods: A total of 229 postmenopausal female patients with low back pain were retrospectively selected from the outpatient and inpatient departments of spine surgery in our hospital from December 2017 to December 2018. Patients′ demographics data such as age, height, weight, diabetes history, hypertension history, drinking history and smoking history were recorded. BMD of the lumbar spine(L1-L4) and mean hip were obtained by dual-energy X-ray, and T values were recorded. Each patient received lumbar magnetic resonance imaging(MRI) examination. Participants with a T-score of ≤-2.5 were diagnosed with osteoporosis, those with a T score of -2.5 to -1.0 were diagnosed with osteopenia, and those with a T-score of ≥-1.0 were considered normal. According to the BMD values, all patients were divided into osteoporosis(n=78), osteopenia(n=73) and normal(n=78) groups. The degree of lumbar disc degeneration at each level was scored using Pfirrmann grading system to correlate with lumbar and hip BMD. Covariance and Spearman correlation analysis were used to analyze the relationship between lumbar and hip BMD and lumbar disc degeneration. Results: The age of the osteoporosis group was significantly higher than that of the normal group(67.17±9.99 years vs 55.29±12.35 years, P＜0.05) and so was that of osteopenia group than normal group(65.66±10.71 years vs 55.29±12.35 years, P＜0.05). The body mass index(BMI) of osteoporosis group was lower than that of the normal group(23.38±2.37 vs 24.72±2.96, P<0.05). There was no significant difference in other general data among the groups(P>0.05). In the upper lumbar spine(L1, L2), the degree of lumbar disc degeneration in the osteoporosis group was lower than that in the normal group (2.24±0.82 vs 2.60±0.95, 2.79±0.95 vs 3.18±0.94, P＜0.05), and no significant difference was found between osteopenia and osteoporosis groups(P>0.05). There was no significant difference in the degree of disc degeneration between the lower lumbar spine(L3, L4) and the hip groups with different BMD. BMD of each lumbar vertebra was positively correlated with the degree of lumbar disc degeneration (L1: r=0.185; L2: r=0.157; L3: r=0.180; L4: r=0.132; L1-L4: r=0.180; P＜0.05), while there was no correlation between hip BMD and lumbar disc degeneration. Conclusions: There is a positive correlation between lumbar disc degeneration and lumbar BMD in postmenopausal women, and higher lumbar BMD were associated with more severe LDD. It is necessary to take a further examination of lumbar spine using CT or MRI. Hip BMD may be a more reliable measurement for diagnosing osteoporosis.