老年性骨密度改变与慢性脊柱源性疼痛的相关性临床观察

目的通过影像学检查,观察老年性骨密度改变与慢性脊柱源性疼痛的相关性。方法随机选择胸背痛伴肋间神经放射痛和腰骶部疼痛伴下肢放射痛患者100例。患者在评价前进行各种影像学检查,而后根据各影像学指标进行相关分级,结合临床VAS评分和症状表现进行分析。观察指标:①根据疼痛相关部位拍摄X线胸腰段和腰骶部正位、侧位及双斜位片,并进行X线片骨质疏松分级评分、脊柱椎体高度测量、脊柱侧弯或前凸指数及脊柱滑脱的分析。②脊柱骨质疏松CT影像学表现观察分析。③脊柱双能X线吸收测定法(DEXA)和分级。④相关脊柱结构改变程度与临床VAS疼痛评分值的相关性分析。结果①三种影像学检查均显示骨质疏松越重,VAS评分值越高(P<0.05),得到了一致性的结果;②椎体压缩的程度与临床VAS评分呈正相关,通过X线平片对椎体压缩高度的评价,以及CT检查结果中椎体后缘皮质可见双边征和小关节突密度增加伴增生的影像学表现分析显示,椎体高度的降低在脊柱源性疼痛发生机制中占重要位置。③从X线平片影像学和CT影像学检查结果分析脊柱存在的病变部位越多,VAS疼痛评分值越高(P<0.05)。结论①骨质疏松的发病进程与VAS疼痛评分值呈正相关,即骨质疏松越严重,疼痛程度也越重;②骨质疏松导致的椎体压缩程度与VAS疼痛评分值呈正相关;③病变部位的多发性与VAS疼痛评分呈正相关,即脊柱发病部位越多,疼痛程度也越重、疼痛范围越广泛。

Study on the relationship between change in bone density and spinal pain in old persons

Objective To observe the relationship between change in bone density and spinal pain in old persons according to imaging examinations.Methods One hundred patients with chest or back pain accompanied by intercostal neuralgia or lumbosacral pain with radiating pain in lower limbs were randomly chosen for this study.All these patients were classified according to their imaging examinations,and combined with their VAS scores and clinical symptoms for analysis.The indicators for measuring were： ① The classification of osteoporosis,height of spinal vertebrarium and the degree of scoliosis or lordosis indices and spondylolisthesis according to the X-ray examination.②Observation and analysis of spine osteoporosis by CT scanning.③ The result of DEXA.④ The relationship of structural change in related spines and VAS scores.Results ①All these three kinds of imaging studies had been shown that VAS scores of patients with more severe osteoporosis were higher than those of mild ones（P 0.05）;②The degree of vertebral compression was positively correlated to VAS scores.③ According to the X-ray and CT imaging findings,the more spinal lesions got higher VAS pain scores（P 0.05）.Conclusion The process of osteoporosis,the degree of vertebral compression and the number of lesions were all positively correlated with VAS scores.