【作者】 郭召；

【导师】 丁文元；

【作者基本信息】 河北医科大学 ， 外科学， 2010， 硕士

【摘要】 目的:退行性腰椎侧凸的发病率占退行性腰椎疾病的6%左右,是一种复杂的脊柱畸形,不仅表现为冠状面上的弯曲,常合并椎体轴位旋转、冠状面侧方移位及矢状面前方移位,多由椎间盘或小关节突退变、骨质疏松等造成脊柱的弯曲畸形,男女比例为1∶2。骨质疏松症是退行性腰椎侧凸的重要发病因素之一,严重的骨质疏松将加快退行性腰椎侧凸的发展。有报道称女性绝经后骨质疏松者退行性腰椎侧凸的发生率明显高于无骨质疏松者。腰椎侧凸还可以继发于骨质疏松引起的压缩骨折,非对称性的压缩骨折可以加重侧凸的程度。伴骨质疏松症的退行性腰椎侧凸患者常有着更广泛的椎间盘退变、小关节增生、黄韧带肥厚、脊柱失稳,多数还伴有脊柱冠状面侧方移位、旋转半脱位和矢状面椎体滑脱。同时骨质疏松症及由其引起的椎体病理性骨折与因退行性腰椎侧凸产生的肌肉劳损、躯干失平衡、腰前凸丢失、关节突关节病、椎管狭窄等因素共同作用将加重患者腰背部疼痛。本研究致力于通过对退行性腰椎侧凸患者骨密度检查及结果的统计学分析,了解两者的相关性,从而为优化手术方案,应对术中可能出现的相关并发症,以及对于病人术前及术后治疗提供理论依据。同时,掌握骨质疏松在退行性脊柱侧凸患者中的发病率,可给予健康指导,尤其对中老年人强调抗骨质疏松的重要性,即在一定程度上可防止退行性腰椎侧凸的发生方法:2007年10月至2009年6月门诊及病房共收治退行性腰椎侧凸患者69例,其中男6例,女63例;平均年龄为69.3±11.4岁;所有患者均行X线、CT、MRI检查,部分患者行脊髓造影检查,根据影像学表现及患者病史询问,明确病情并记录患者Cobb’s角;对照组50例,均为非腰椎侧凸患者,其中腰椎管狭窄症37例,腰间盘突出症8例,腰椎滑脱症4例,腰椎管内占位1例,平均年龄62.6岁。采用我院双能X线吸收仪对患者进行骨密度测定,测定部位包括腰椎(L2-4)及股骨部,记录骨密度值及T值,同时根据不同年龄阶段、Cobb’s角观察退行性腰椎侧凸的T值变化。结果:在69例退行性腰椎侧凸患者中,平均T值为-2.8±1.9,分布在-0.9到-4.7之间,合并骨质疏松52例,骨量减少14例,骨质疏松发生率75.4%,骨量减少发生率17.4%;对照组平均T值-1.2±1.6,分布在1.2到-2.4之间,合并骨质疏松5例,骨量减少17例,骨质疏松发生率10%,骨量减少发生率34%;两组比较有显著统计学差异(p<0.05)。根据不同年龄、Cobb’s角退行性腰椎侧凸患者的T值比较,发现骨质疏松程度与年龄呈明显正相关,而与Cobb’s角零相关。结论:骨质疏松症是退行性腰椎侧凸发病的危险因素,两者存在显著的相关性,在本组发病率为75.4%,同时骨质疏松程度随着年龄的增大而增加,与侧凸程度无明显相关。更多还原

【Abstract】 Objective: The incidence of degenerative lumbar scoliosis(DLS) was accounted for 6% of degenerative lumbar diseases. DLS is a complex spinal deformity, not only for the coronal plane bending, but often associated with vertebral axial rotation, lateral shift of coronal plane and frontal displacement of sagittal plane. Ratio between male and female was 1:2. It is often caused by osteoporosis and degeneration of intervertebral disc and facet joint. Decreased bone density was initially considered to be the important cause of DLS, severe osteoporosis will accelerate the development of degenerative lumbar scoliosis. It is reported that women with postmenopausal osteoporosis have significantly higher incidence of DLS than those without osteoporosis. DLS can also be secondary to osteoporotic compression fractures, non-symmetry of the compression fracture can increase the degree of scoliosis. patients with degenerative lumbar scoliosis often have a wider range of disc degeneration, facet joint hyperplasia, hypertrophy of ligamentum flavum, spinal instability when assosiated with osteoporosis, usually accompanied with lateral displacement of the spine coronal plane, rotation, subluxation and olisthesis. At the same time, osteoporosis, muscle strain, trunk loss of balance, loss of lumbar lordosis, facet joint disease, spinal stenosis and other factors will together increased patients’low back pain. The study is committed to master the correlation of DLS and osteoporosis through the statistical analysis of BMD and T values, then to supply a theoretical basis for preoperative and postoperative treatments, optimize the suigical programs, and decrease the complications on and after surgery. Meawhile, mastering the incidence of degenerative assosiated osteoporosis could give health guidances, stressed the importance of anti-osteoporosis especially for the elderly, an prevent the occurrence of degenerative lumbar scoliosis on some extent. Method: From Oct.2007 to May.2010, 69 patients diagnosised with degenerative scoliosis from out-patient and wards were included in the group. There were 6 males and 63 females with an average age of 69.3 years(ranged from 58 to 81 years). To comfirm the diagnosis, all the patients underwent X-Ray , CT and MRI examines, several patients underwent myelography, Cobb’s angle was recorded respectively. Control group had 50 cases without scoliosis, including 37 spinal stenosis, 8 lumbar disc herniation, 4 spondylolisthesis and 1 lumbar spinal tumor. The bone density of lumbar(L2-4) and proximal femoral regions was measured with dual-energy x-ray absorptiometry. BMD and T values were recorded. The change of T values of diffierent ages and Cobb angles was observed to analyze the ralationship between them. Statistical analysis were performed with SPSS 13.0.Result: Of the 69 cases with degenerative scoliosis, the average T-score was -2.8±1.9(distributed from -0.9 to -4.7), 52 cases combined with osteoporosis, 14 cases combined with osteopenia, the incidence of osteoporosis was 75.4%, the incidence of osteopenia was 17.4%; the average T-score in the control group was -0.6±1.8(distributed from 0.4 to -2.8), 5 cases combined with osteoporosis, 17 cases combined with osteopenia, the incidence of osteoporosis was 10%, the incidence of osteopenia was 34%. Significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups(p<0.05). According to the comparision of T-score in different ages and Cobb’s angles, the T-score has a positive correlation with age, and zero correlation with Cobb’s angle.Conclusion: Osteoporosis is a risk factor for degenerative scoliosis, there exists a significant correlation, in this cohort the incidence is 75.4%. Curve magnitude doesn’t correlate with the severity of osteoporosis.更多还原