【作者】 刘爱华；

【导师】 林海滨；

【作者基本信息】 福建中医药大学 ， 中医骨伤科学， 2010， 硕士

【摘要】 目的：通过对下腰椎间盘突出症(Low Lumber Disc Herination, LLDH)患者腰椎骨性结构参数的测量和比较,分析这些参数的变化和LLDH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：1资料的收集：2008-2010年收住莆田学院附属医院骨科的腰椎间盘突出症患者485例,随机抽取符合纳入标准的207例作为实验组；2008-2010年因慢性腰腿痛就诊我院骨科门诊患者700例,随机抽取符合纳入标准及CT检查显示无腰椎间盘突出者143例作为对照组。2腰椎间盘突出症的诊断标准(依据胡有谷提出的诊断标准)：2.1腿痛重于腰痛,腿痛呈典型的坐骨神经分布区域的疼痛。2.2按神经分布区域的皮肤感觉麻木。2.3直腿抬高较正常减少50%,兼或有好腿抬高试验阳性,作弓弦试验即胭窝区域指压胫神经引起肢体远近两端的放射痛。2.4出现四种神经体征中的两种征象(肌肉萎缩、运动无力、感觉减退和反射减弱)。2.5与临床检查一致水平的影像学检查发现,包括椎管造影、CT或MRI等。3纳入标准：3.1符合LLDH诊断标准者；3.2年龄在25～65岁之间；3.3 CT/MRI检查示L4/L5、L5/S1节段腰椎间盘突出者。4排除标准：4.1腰椎骨折、肿瘤、结核、感染、手术后等破坏腰椎后部正常解剖结构等疾病；4.2马尾神经综合症及双下肢瘫痪的患者;4.3非L4/L5、L5/S1节段腰椎间盘突出者。5资料分组：350例按病情分为对照组和实验组；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、54-65岁组。6测量参数：6.1棘突偏斜角：即棘突(中心线)与矢状面的偏斜角。同时记录棘突偏向突出间盘同侧,对侧或中央突出；6.2关节突关节角(transverse interfacet angel法)：CT扫描要求平行终板,取椎间盘前后左右缘切线围成的长方形中心为椎间盘中心。取棘突基部中心与椎间盘中心连线为腰椎矢状轴,关节突关节面内外端点连线与腰椎矢状轴夹角为关节突关节角。两侧关节突关节形态不同或两侧关节突关节角度之差≥10°定义为关节突关节不对称,同时记录关节突的非对称性及椎间盘突出分型；6.3腰椎曲度角(Cobb’s法)：即T12下缘切线延长线与S1上缘切线延长线所成的角；6.4腰骶关节角(Gronkopff法)：在腰椎侧位片上L5椎体上下缘的中央连线和Sl椎体上下缘的中央连线相交所成的角,参考值范围为143°：结果：1病例组与对照组的棘突偏斜角在L4、L5水平存在差异,数据不呈正太分布,应用轶和检验,Z值为-10.609,-12.074 P<0.01。2病例组与对照组的关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在各年龄组及总体比较无显著性差异,P>0.05。3从性别上看,男、女组仅在腰骶关节角上有显著性差异,P=0.007<0.01；从年龄段间比较,关节突非对称性、腰椎生理曲度、腰椎曲度角、腰骶角在56～65岁组分别于25～35岁组、36～45岁组之间比较有显著差异性,(P<0.01),在46-55岁组和25-35岁组组之间有显著差异性,(P<0.01)。结论：本组研究显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的退行性改变中的作用是不可否认的。更多还原

【Abstract】 Objective:To measure and compare the construction parameters of lumbar spine bone structure in low lumbar disc herniation(LLDH) and to analyze dependability between changes of texture Parameters of lumbar vertebra and LLDH.the study was to investigate whether abnomalities of lumbar bony structure could lead to LLDH and to evaluate the importance of degeneration in degenerative lumbar disc.Materials and Methods:1 Date and case:2006 to 2008 hospitalizes in the orthopedics of the Affiliated Hospital of PuTian University with LLDH has 485 case,Screened 207 case of LLDH were randomly selected from them for the case group,143 cases of lumbar intervertebra disc unprotrusion were randomly selected from the patients with lumbar spine CT examinations in our hospital for the control group..2 Diagnostic criteria for lumbar disc herniation (according to Hu have proposed diagnostic criteria Valley):2.1 Leg suffers from the pain more then low spine which is the typical pain of the distribution area of sciatic nerve;2.2 The skin which the area distributed sciatic nerve feels numbness;2.3 Compared with the normal Lasegue-test reducing by 50%; and or the normal lasegue-test was positive,the radiating pain for whole leg caused by the Bowstring test;2.4 Nervous signs appeared in two of four signs (muscle atrophy, motor weakness, sensory loss and reflex decreased).3 Internalize standard:3.1 The patients meet the diagnostic criteria of the LLDH;3.2 Age range 25 to 65 years old;3.3 Lumbar disc herniation occurs at the L4/5 and L5/S1.4 Exclusion standard:4.1 Vertebral fracture, tumor, tuberculosis, infection,after surgery such as destruction of normal anatomy of posterior lumbar spine and other diseases;4.2 Cauda equina syndrome and patients with lower limb paralysi;4.3 Lumbar disc herniation did not occur at the L4/5 and L5/S1.5 Data Packet350 cases classified patient group and control group according to the information of pathogenetic condition;According to ages,divide it into 25 to 35 group;36 to 45 group;46 to55 6 Parameter measurement6.1 Spinous process deflection angle:the spinous process (centerline) and the sagittal plane of the deflection angle (see figure 1). At the same time tend to highlight the inter-disc recording spinous ipsilateral, contralateral or central prominence;6.2 Facet joint angle (transverse interfacet angel France):CT scan of parallel end-plates, taken all around edge of disc tangent center surrounded by a rectangular disc center. Take spinous process base center and center connection for lumbar intervertebral disc sagittal axis, Facet endpoint connections within and outside the sagittal axis angle and lumbar facet joint angle for the (d). Both sides of the facet joint morphology different and (or) both sides of the facet joint angle difference≥10°is defined as the facet joint asymmetry, while recording the non-symmetry of facet joints and the disc sub-type;6.3 Lumbar vertebrae curvature (Seze’S method):The forthcoming T12-S1 posterior margin of the formation of an arc-arc connection, measuring the distance from the top of the strings shall lumbar curvature;6.4 Angle of lumbar vertebrae curvature (Cobb, s law) that the T12 tangent to extend the line and the lower edge of the upper edge of S1 to extend the lines into the tangent of the angle;6.5 Lumbosacral angle (Gronkopff method):In the L5 lumbar vertebra on the lateral view the upper and lower edge of the central connection, and S1 vertebrae to connect the upper and lower edge of the central government into a corner of the intersection of the reference value range of 143°.Results1 Process deflection angle at L4, L5 levels had a significant statistical difference between the prominent group and the control. The date showed normal distribution.Using Rank sum test,it had a significant statistical difference (Z=-10.609,-12.074,P<0.01).2 The analysis show that there was not significant statistical difference(P=0.065 >0.05) compared the patient group and the control group on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle.3 There only was significant difference on Lumbosacral angle between male group and female group (P=0.007<0.01);There was significant difference on the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 54-65 age group and 25-34 age group or 35-44 age group (P<0.01);There was significant differenceon the facet asymmetry,Lumbar vertebrae curvature,Angle of lumbar vertebrae curvature and Lumbosacral angle between 45-54 age group and 25-34 age group (P=0.0056<0.01).Conclusion:This group of studies have shown that the abnomalities of lumbar bony structure could not lead the lumbar disc herniation;But the abnomalities of lumbar bony structure aggravate the lumbar intervertebral disc degenerative.更多还原