髂骨旋转移位与L4,5椎间盘退变之间的相关性生物力学分析

目的 :研究髂骨旋转移位与L_(4,5)椎间盘退变之间的生物力学关系,为防治L_(4,5)椎间盘的退变、突出提供临床依据。方法:自2012年3月至2014年2月,选取腰椎间盘突出症合并骶髂关节紊乱68例。其中L_(4,5)椎间盘突出症合并骶髂关节紊乱42例,男22例,女20例;年龄19~63岁,平均(51.78±20.18)岁;病程1~126个月,平均(11.18±9.23)个月。L5S1椎间盘突出症合并骶髂关节紊乱26例,男11例,女15例;年龄18~65岁,平均(45.53±27.23)年;病程0.5~103个月,平均(11.99±12.56)个月。为患者拍摄腰椎正位片68张,腰椎侧位片68张,骨盆平片68张,测量骨盆倾斜度、腰椎侧弯度和椎间盘厚度。直线与回归方法研究骨盆倾斜度与腰椎侧弯度、腰椎侧弯度与椎间盘厚度之间的相关性,并进行生物力学分析。结果:L_(4,5)椎间盘突出中骨盆倾斜度与腰椎侧弯之间呈正相关性(R=0.49,P=0.00),两变量之间有因果直线关系与良好的比例关系(Y=3.05+1.07X,P=0.00),男性L_(4,5)椎间盘突出患者腰椎侧弯与L4-L5椎间隙之间呈负相关(R=-0.50,P=0.01),两变量之间有因果直线关系与良好的比例关系(Y=13.09-0.27X,P=0.02),而L5S1椎间盘突出中男性患者腰椎侧弯与L5S1椎间隙之间呈正相关(R=0.46,P=0.04)。结论:髂骨旋转移位与L_(4,5)椎间盘退变、突出生物力学密切相关,为临床治疗慢性顽固性L_(4,5)椎间盘突出症患者提供了新的认识理念和治疗途径。

Biomechanical analysis on the correlation between iliac rotation displacement and L4,5 disc degeneration

Objective: To study the biomechanical relationship between iliac rotation displacement and L_4,5 disc degeneration,and to provide clinical evidences for the prevention and treatment of L_4,5 disc degeneration and herniation. Methods: From March 2012 to February 2014,68 patients with lumbar disc herniation combined with sacroiliac joint disorders were selected. Among them,42 patients with L_4,5 disc herniation combined with sacroiliac joint disorders included 22 males and 20 females,ranging in age from19 to 63 years old,with an average of (51.78±20.18) years old,and the duration of the disease ranged from 1 to 126 months with an average of (11.18±9.23) months. Twenty-six patients with L₅S₁ disc herniation combined with sacroiliac joint disorders included 11 males and 15 females,ranging in age from18 to 65 years old with an average of (45.53±27.23) years old,and the duration of the disease ranged from 0.5 to 103 months with an average of(11.99±12.56) months. Sixty-eight anteroposterior lumbar radiographs,68 lateral lumbar radiographs,and 68 pelvic plain films were taken. The degree of lumbar scoliosis,pelvic tilt,and disc thickness were measured. The correlation between pelvic tilt and lumbar scoliosis,lumbar scoliosis and disc thickness were studied by using linear and regression methods. The biomechanical analysis was performed. Results: There was a positive correlation between pelvic tilt and lumbar scoliosis in patients with L_4,5 disk herniation(R=0.49,P=0.00). There was a causal relationship and good linear proportional relationship (Y=3.05+1.07X,P=0.00) in the two variables. There was a negative correlation between lumbar scoliosis and intervertebral space in male patients with L_4,5 disk herniation (R=-0.50,P=0.01). There was a causal relationship and good linear proportional relationship in the two variables (Y=13.09-0.27X,P=0.02). But there was a positive correlation between lumbar scoliosis and intervertebral space in male patients with L₅S₁ disk herniation (R=0.46,P=0.04). Conclusion: Iliac rotational displacement are closely related with L_4,5 disc degeneration and herniation in biomechanics. A new concepts and therapeutic approach is provided for clinical treatment of chronic and refractory herniation of L_4,5 disc in patients.