【作者】 杜鑫冲；

【导师】 董玉昌；

【作者基本信息】 河北医科大学 ， 外科学， 2011， 硕士

【摘要】 目的:脊柱的椎间盘突出好发于颈椎和腰椎,但是胸腰段椎间盘突出在临床上相对比较少见。而且关于胸腰段椎间盘突出症目前临床报道也不多。近年来,随着对本病认识的不断深入及影像学诊断技术的不断发展,尤其是磁共振(MRI)检查应用的日益广泛,目前本病的诊断率有上升的趋势。胸腰段椎间盘突出症临床表现较为复杂且缺乏特异性,容易发生误诊或漏诊,而且发病机制仍不很清楚,许多专家、学者各抒己见,未能形成比较统一的共识。胸腰段椎间盘突出症由于其解剖结构的复杂性,手术治疗较下腰椎手术具有较大风险,所以研究胸腰段椎间盘突出的病因,避免其发生,显得极为重要。胸腰段位于腰椎前凸与胸椎后凸的结合部,是承载应力的集中部位,脊柱骨折好发于此。压缩或楔形压缩骨折仅仅累及前柱,被认为是稳定骨折。轻度压缩骨折在临床上被认为没有太大意义,因为不存在即刻的神经压迫症状,广泛采用非手术治疗。本研究通过对比研究胸腰段椎间盘突出患者(实验组)与年龄性别匹配的志愿者(对照组)目标椎体的后凸角和cobb角来确定胸腰段椎间盘突出与邻近节段楔形椎体是否具有相关性。方法:回顾性分析自2003年至2009年间于我院行行手术治疗的患单节段胸腰段椎间盘突出症的患者56例。排除近期内有外伤史,感染,肿瘤以及骨质疏松的患者,剩余43例。此43例患者为实验组。共有29例男性,14例女性。平均年龄为43岁(19-66岁)。在2010年间,共有43例健康的志愿者组成对照组,对照组与实验组的年龄及性别相匹配。实验组中共有31例患者有高处坠落或交通事故导致的腰背部外伤史,外伤史距手术日期均超过3年。其余12例患者否认腰背部外伤史。所有43例对照组患者否认腰背部外伤史。所有的患者及志愿者均接受站立位侧位X光片检查。目标椎体被定义为邻近椎间盘突出节段的楔形椎体。在实验组中,T12/L1椎间盘突出17例,L1/2椎间盘突出15例,L2/3椎间盘突出11例。10个楔形椎位于T12,19个位于L1,14个位于L2。将两组对象根据目标椎体的位置各分为3个亚组。在实验组中,目标椎体的cobb角度和后凸角度被分别测量(图1)。对照组中,根据年龄对应关系,测量与实验组目标椎体相应的椎体的cobb角度和后凸角度。取后凸作为角度的正值,前凸作为负值。为避免误差,所有X光片被打印在纸上并复印为3份,根据盲法分发给3位脊柱专业研究生,将他们的测量所得值取平均数。所有数据采用统计软件包SPSS13.0软件进行统计分析。两组的cobb角度采用两样本t检验(符合正态分布)比较。两组的后凸角度采用秩和检验进行比较(不符合正态分布)。后凸角在两组组间及对应的亚组间进行比较,cobb角在对应的亚组间比较。cobb角和后凸角的相关性采用线性回归分析检验。统计标准被定义为小于0.05。结果:Cobb角实验组的cobb角大于对照组。T12的cobb角实验组为19±7o,对照组为6±3(op=0.0002<0.05)。L1的cobb角实验组为13±7o,对照组为3±6o(p=0.0001<0.05)。L2的cobb角实验组为10±6o,对照组为-2±7o(p=0.0001<0.05)。后凸角实验组的后凸角度在整体和亚组均大于对照组。T12的后凸角实验组为10o±4o,对照组为2°±2°(p=0.0002<0.05)。L1的后凸角实验组为12°±4o,对照组为3°±3°(p=0.0001<0.05)。L2的后凸角实验组为10o±2°,对照组为2°±2°(p=0.0001<0.05)。实验组整体的后凸角为11o±4o,对照组为2°±2°(p=0.0001<0.05)。实验组所有的后凸角均小于22°(4°to 22°),对照组的后凸角均小于7°(0°to 7°)。两组的后凸角与cobb角之间没有相关性(p<0.05)。实验组的后凸角(平均11o,范围4-22°)大于对照组的后凸角(平均2°,范围0-7o),具有统计学意义(p<0.05)。实验组的cobb角在各亚组间比较也大于对照组,具有统计学意义(p<0.05)。在后凸角与cobb角之间没有线性相关性。结论:胸腰段椎间盘突出与邻近节段的楔形椎体之间具有相关性。根据我们的研究,较小的椎体压缩后凸畸形不应被忽略,长期随访应被进行。手术治疗如椎体成型术或许应被考虑采用以避免椎体压缩引发的邻近椎间盘生物力学改变及退变。更多还原

【Abstract】 Objective: Spinal disc herniation is most commonly found on the cervical spine and lumbar spine, but thoracolumbar intervertebral disc herniation is relatively rare in clinic. At present there is a little literature about thoracolumbar intervertebral disc herniation. In recent years, With the further understanding of the thoracolumbar intervertebral disc herniation and unceasing development of imaging diagnosis technology , especially MRI is being applied more and more widely, the diagnosis of this disease at present is rising trend. The clinical manifestations of thoracolumbar intervertebral disc herniation are complex and lack of specificity, so it is prone to misdiagnosis or missed diagnostic. Besides, the pathogenesis of thoracolumbar intervertebral disc herniation is still not very clear. Different experts have different ideas and they failure to form a unified consensus. Due to the complexity of anatomical structure of thoracolumbar intervertebral disc herniation,the risk of surgical treatment is more than the lower lumbar spine. Therefore, to study the etiology of thoracolumbar intervertebral disc herniation and avoid it appear very important. thoracolumbar spine located in the junction of lumbar lordosis and thoracic kyphosis and it is the sites which beared stress concentration. Thoracolumbar spine was apt to suffer from Spinal fracture. Wedge compression fracture barely involved the anterior column, so it was considered stable fracture. Mild compression fractures in the clinical were considered very little significance. Because there is not immediate symptoms of nerve compression, non-surgical treatment was widespread use in mild compression fractures. The aim of this research is to make a comparison on target vertebral kyphosis angles and cobb angles of the patients who suffered from thoracolumbar intervertebral disc herniation (experimental group) and the age and gender-matched volunteers (control group) , so as to reach a conclusion on whether is there any correlation between the thoracolumbar intervertebral disc herniation and adjacent wedge-shaped vertebral body.Methods: Totally 56 patients with thoracolumbar intervertebral disc herniation who were operated from 2003 to 2009 at the Third Clinical Hospital of Hebei medical university were retrospectively analyzed. Exclusion the patients who had a history of trauma in recent period, infection, cancer and osteoporosis, the remaining was 43 cases. The 43 patients were the experimental group. There is a total of 29 male and 14 female patients. The average age was 43 years (19-66 years). In 2010, a total of 43 healthy volunteers formed the control group. The control group and experimental group were matched by age and gender. In experimental group, 31 patients had the history of lower back injury caused by falls from a height or traffic accidents. The history of trauma from the surgery date was more than 3 years. The remaining denied history of lower back injury. All 43 cases of control group patients denied history of lower back injury. All patients and volunteers underwent standing lateral X-ray examination. Target vertebra is defined as adjacent wedge-shaped vertebral body of thoracolumbar intervertebral disc herniation. In the experimental group, T12/L1 disc herniation 17 cases, L1 / 2 disc herniation 15 cases, L2 / 3 disc herniation 11 cases. 10 wedge-shaped vertebral body at T12, 19 were in L1, 14 were in L2. According to the target vertebra, Two groups were divided into 3 subgroups. In experimental group, the cobb Angles and the kyphosis angles of target vertebra were measured respectively (figure 1).According to correspondence of age, In the control group cobb angle and kyphosis angle of the corresponding vertebral body with the experimental group’s target vertebra were measured. It is defined that Kyphosis angle as a positive and lordosis angle as a negative To avoid errors, all X-ray films were printed on papers and 3 copies of copies. According to blind, they were distributed to three spine professional graduate studentsand we took their measurements average value. Statistical analysis of all data was used by statistical software package for statistical analysis SPSS13.0. Cobb angles of the two groups using two-sample t test (the normal distribution) to compare. Kyphosis angles of the two groups were compared by rank sum test (does not meet the normal distribution). Kyphosis angles were compared between the two groups and the corresponding subgroups. cobb angles were compared between the corresponding subgroups. Correlation test of cobb angle and kyphosis angle used the linear regression analysis. Statistical standard is defined as less than 0.05.Results: Cobb angle Cobb angles of the experimental group was higher than the control group. Cobb angle of T12 for the experimental group was 19±7 o, and control group was 6±3°(p = 0.0002 <0.05). Cobb angle of L1 for the experimental group was 13±7 o, and control group was3±6o(p=0.0001<0.05). Cobb angle of L2 for the experimental group was 10±6o,and control group was -2±7o(p=0.0001<0.05)).kyphosis angle kyphosis angle in the experimental group and subgroup were higher than the control group. The kyphosis angle of T12 in experimental group was 10 o±4 o,and Control group was 2°±2°(p = 0.0002 <0.05). The kyphosis angle of L1 in experimental group was 12o±4o,and Control group was 3o±3o(p=0.0001<0.05). The kyphosis angle of L2 in experimental group was 11o o±4 o,and Control group was 2°±2°(p = 0.0001 <0.05).All of the Cobb angle in experimental group were less than 22°(4°to 22°),and All of kyphosis angle of the control group were less than 7°(0°to 7°). There is the no correlation between Kyphosis angle and the cobb angle in two groups (p <0.05). Kyphosis angle of the experimental group (average 11 o, range 4-22°) larger than the control group (average 2°, range 0-7 o),with statistically significant (p <0.05). Cobb angle in the experimental group and the various sub-groups are also larger than the control group, with statistical significance (p <0.05). There is no linear correlation between the Cobb angle and the kyphosis angle.Conclusion: There is correlation between thoracolumbar intervertebral disc herniation and adjacent wedge-shaped vertebral body. According to our research, the smaller vertebral kyphosis should not be ignored, and long-term follow-up should be carried out. Surgical treatments such as percutaneous kyphoplasty should probably be considered to operate to prevent biomechanical changes and adjacent disc degeneration caused by vertebral compression.更多还原