摘要
目的 探讨青年腰椎间盘突出症与脊柱矢状面Roussouly分型之间关系.方法 横断面回顾性分析2020年1月至2021年12月我院住院的126例符合纳入、排除标准的腰椎间盘突出症的患者,在站立位全脊柱侧位X线片上测量骨盆投射角(PI)、骨盆倾斜角(PT)和骶骨倾斜角(SS),在腰椎CT水平面片上测量突出节段双侧关节突关节角(FJA),矢状位片上测量突出节段椎间盘前、中、后缘高度,在腰椎MRI片判断Pfirrmann椎间盘退变分级,根据矢状面形态进行Roussouly分型,并对各组数据间进行分析.结果 126例患者,年龄18～40岁,平均(31.04±5.89)岁.L4～5椎间盘突出63例,L5～S1突出59例,L3～4突出4例.Roussouly分型中1型21例、2型56例、3型32例、4型4例、前倾3型13例,L4～5椎间盘突出组2、3型明显高于其他组,L5～S1椎间盘突出组1、2型明显高于其他组,各组之间椎间盘退变Pfirrmann分级、椎间隙前缘、椎间隙后缘及椎间隙中间高度、左右侧关节突关节角及双侧关节突关节角差值、TK值比较差异均无统计学意义(P＞0.05).各组之间PI、PT、SS、LL、椎间隙前-后缘高度差值比较,差异有统计学意义(P＜0.05).PI值以50°分组比较,PT、SS、LL差异有统计学意义(P＜0.05),两组之间TK值差异无统计学意义(P＞0.05).L4～5单节段内PT、SS、LL差异有统计学意义(P＜0.05),TK值差异无统计学意义(P＞0.05).SS值以35°分组比较,两组PI、TK、LL差异有统计学意义(P＜0.05),按照突出节段分为L4～5和L5～S1两组比较,PI、PT、椎间隙前缘高度、椎间隙前-后缘高度差、左侧关节突关节角、右侧关节突关节角、双侧关节突关节角差值差异有统计学意义(P＜0.05).结论 腰椎间盘突出症病例中PI＜50°,SS＜35°发生率明显偏高,即Roussouly 1、2型发生率明显偏高,Roussouly 4型最少.
Abstract
Objective To investigate the relationship between young lumbar disc herniation and Roussouly classification of spinal and pelvic sagittal plane.Methods A cross-sectional retrospective analysis was performed on 126 patients with lumbar disc herniation admitted to our hospital from January 2020 to December 2021 according to the inclusion and exclusion criteria.The pelvic incidence(PI),pelvic tilt(PT),and sacral slope(SS)were measured on full lateral radiographs in standing position.The bilateral facet joint angles(FJA)were measured on lumbar CT horizontal radiographs,and the anterior,middle and posterior edge heights of the disc were measured on sagittal radiographs.The Pfirrmann disc degeneration grade was determined on lumbar MRI,Roussouly classification was performed according to sagittal plane morphology,and the data of each group was analyzed.Results 126 patients with the age from 18 to 40 years,and an average age of(31.04±5.89)years were recorded.There were 63 cases of L4～5 herniation,59 cases of L5～S1 herniation and 4 cases of L3～4 herniation.In Roussouly's classification,there were 21 cases of type 1,56 cases of type 2,32 cases of type 3,4 cases of type 4 and 13 cases of forward-leaning type 3.The number of Type 2 and 3 cases of L4～5 disc herniation group was significantly higher than that of other groups,and the number of type 1 and 2 cases of L5～S1 disc herniation group was significantly higher than that of other groups.There was no significant difference in the Pfirrmann grade of disc degeneration,the leading edge of the intervertebral space,the posterior edge of the intervertebral space,the middle height of the intervertebral space,the angle difference of the left and right facet joints,the angle difference of the bilateral facet joints,and the TK value among all groups(P＞0.05).There were significant differences in PI,PT,SS,LL and the height differ-ence between anterior and posterior intervertebral space among all groups(P＜0.05).When compared according to 50°,the PI values of PT,SS and LL were significantly different(P＜0.05),while TK value was not significantly different between the each group(P＞0.05).There were significant differences in PT,SS and LL in L4～5 segment(P＜0.05),but without significant difference in TK(P＞0.05).When compared according to 35°,the SS values had significant differences in PI,TK and LL between each group(P＜0.05).According to the protrusion segment,L4～5 and L5～S1 were calssified as two groups.There were signifi-cant differences in PI,PT,anterior space height,anterior to posterior space height difference,left facet joint angle,right facet joint angle and bilateral facet joint angle difference(P＜0.05)between the two.Conclusion In cases of lumbar disc herniation,the incidence of PI＜50° and SS＜35° is significantly higher,that is,the incidence of Roussouly type 1 and 2 is significantly higher,while Roussouly type 4 is the least.
维普
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