下腰椎骨性结构参数与腰椎间盘突出症的关系

背景：腰椎各骨性结构参数的变化是下腰部脊柱骨性结构的形态改变的直接反应，这种改变很可能是在长期受到外在或内在因素影响后脊柱正常结构应变的结果，但不同参数反映的情况是否相同以及与对应的临床症状是否有相关性尚待探讨。目的：测量和比较下腰椎间盘突出症患者的腰椎骨性结构参数，分析参数变化与下腰椎间盘突出症的相关关系。探讨腰椎骨性结构的异常是否为腰椎间盘突出症的病因，以及在腰椎间盘退行性变中的意义。方法：纳入2008年3月至2010年3月解放军南京军区福州总院第一附属医院骨科收治的腰椎间盘突出症患者207例，同期于放射科行CT检查显示非腰椎间盘突出者143例作为对照组。按性别差异分为男、女组；按年龄分为25-34岁组、35-44岁组、45-54岁组、55-65岁组。测量的腰椎骨性结构参数包括棘突偏斜角、关节突关节角、腰椎曲度、腰椎曲度角、腰骶关节角。结果与结论：腰椎间盘突出症组与对照组的棘突偏斜角在L4、L5水平存在差异，数据不呈正态分布，应用秩和检验，Z值为-10.609，-12.074，P〈0.01。腰椎间盘突出症组与对照组的关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶关节角在各年龄组及总体比较差异无显著性意义（P〉0.05）。从性别上看，男、女组仅在腰骶关节角上差异有显著性意义（P=0.007〈0.01）；各年龄段间比较，55-65岁组关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶关节角分别与25-34岁组、35-44岁组之间比较差异有显著性意义（P〈0.01），在45-54岁组和25-34岁组之间差异有显著性意义（P〈0.01）。提示腰椎骨性结构参数的变异不是直接导致腰椎间盘突出症的发病原因，但腰椎骨性结构参数的异常在腰椎间盘退行性改变中的作用是不可否认的。

Relationship between bone structure parameters in lower lumbar spine and lumbar disc herniation

BACKGROUND：Changes in the parameters of lumbar spine bone structure are direct reaction of morphological changes in lower lumbar spine bone structure. These changes possibly result from normal structure strain of the spine affected by long-term external or internal factors. Whether the conditions reflected by different parameters are identical, and whether corresponding clinical symptoms are correlative stil deserves further exploration. OBJECTIVE：To measure and compare the construction parameters of lumbar spine bone structure in lower lumbar disc herniation patients, and to investigate whether abnormalities of lumbar bony structure could lead to lower lumbar disc herniation and to evaluate the significance in degenerative lumbar disc. METHODS：From March 2008 to March 2010, 207 cases of lower lumbar disc herniation were randomly selected from the Department of Orthopedics, First Affiliated Hospital, Fuzhou General Hospital, Nanjing Military Area Command of Chinese PLA. They received CT examination at the Department of Radiology at the same period, and results revealed that 143 cases of lower lumbar disc non-herniation served as control group. According to gender, they were divided into male and female groups. According to ages, they were divided into 25-34 group, 35-44 group, 45-54 group and 55-65 group. They were studied by measuring spinous process deflection angle, facet joint angle, lumbar vertebrae curvature, angle of lumbar vertebrae curvature, lumbosacral angle. RESULTS AND CONCLUSION：Process deflection angle at L 4 and L 5 levels had a significant statistical difference between the lower lumbar disc herniation group and the control group. The date did not show normal distribution. Using Rank sum test, it had a significant statistical difference （Z=-10.609,-12.074, P〈0.01）. There was not significant statistical difference between the lower lumbar disc herniation group and the control group on the facet asymmetry, lumbar vertebrae curvature, angle of lumbar vertebrae curvature and lumbosacr