青少年与中老年腰椎间盘突出症患者腰骶矢状位参数对比研究

发布时间：2018-04-24 07:23

本文选题：青少年腰椎间盘突出症 + 腰椎前凸角　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:通过测量青少年组和中老年组腰椎间盘突出症患者的腰椎前凸角和骶骨倾斜角,对两组测量数据进行统计学分析,比较两个年龄段患者腰骶矢状位参数是否存在显著差异,并探讨其临床意义。方法:选取2013年6月至2016年6月于我科住院治疗,诊断为腰椎间盘突出症的青少年及中老年患者各47例,其中青少年组年龄区间14~25岁,平均20.4±3.0岁,有10例患者合并双侧乆绳肌紧张;中老年组年龄区间40~60岁,平均54.1±5.1岁。选取治疗前腰椎侧位X线片,分别取经过L1椎体上终板和经过S1椎体上终板的切线,两切线夹角作为腰椎前凸角,以Cobb角测量方法进行测量;取经过S1椎体上终板的切线与水平线相交所得夹角为骶骨倾斜角并测量角度。测量精度为0.1°。对所得两组数据组内做Pearson相关分析、组间做独立样本t检验等统计学分析以明确差异显著性。结果:青少年组腰椎前凸角平均值为31.4°±11.3°,骶骨倾斜角平均值为29.6°±7.6°。其中合并双侧乆绳肌紧张的10例患者腰椎前凸角平均值为30.8°±5.4°,骶骨倾斜角平均值为27.6°±2.0°,其余青少年组37例患者腰椎前凸角平均值为31.6°±12.5°,骶骨倾斜角平均值为30.1°±8.4°。中老年对照组腰椎前凸角平均值为37.9°±7.2°,骶骨倾斜角平均值31.6°±7.5°。青少年组的腰椎前凸角显著小于中老年对照组(P0.05);青少年组的骶骨倾斜角同中老年组相比也较小,但无统计学差异(P0.05)。Pearson相关分析显示在青少年组和中老年组中,腰椎前凸角与骶骨倾斜角均密切相关。结论:1.青少年腰椎间盘突出症患者的腰椎前凸角较中老年患者显著减小,腰椎曲线更趋向于垂直化排列,椎间盘的垂直应力负荷及后部纤维环的剪切力负荷相对更重。2.合并双侧乆绳肌紧张的青少年腰椎间盘突出症患者其腰椎前凸角、骶骨倾斜角与组内其它患者相比平均值较小,考虑为乆绳肌异常收缩造成的骨盆后倾,同时腰椎曲度继发性减小所致,其原因有待进一步研究。3.青少年患者骶骨倾斜角同中老年组相比虽较小,但差异不显著。4.由于异常状态的乆绳肌可能导致腰椎趋向垂直化排列,加快椎间盘退变进程,应专注于患有双侧乆绳肌紧张的青少年进行后续前瞻性研究,观察腰骶矢状位参数变化及间盘退变的相关病理表现,以明确乆绳肌异常收缩在腰椎间盘突出症发病机制上的重要性,有助于更好地制定该病的预防措施。
[Abstract]:Objective: to measure the lumbar kyphosis angle and sacral obliquity angle of patients with lumbar intervertebral disc herniation in adolescent group and middle and old age group, and to analyze the data of the two groups statistically. To compare the difference of lumbosacral sagittal parameters between the two age groups and to explore its clinical significance. Methods: from June 2013 to June 2016, 47 adolescents and 47 middle-aged and elderly patients with lumbar disc herniation were enrolled in our department. The average age of the adolescent group was 20.4 卤3.0 years, with an age interval of 1425 years. There were 10 cases with bilateral tension of cordis muscle, the middle and old age group was 4060 years old with an average of 54.1 卤5.1 years old. The lateral radiographs of the anterior lumbar vertebrae were selected and the tangent lines passing through the upper end plate of L1 and the superior end plate of S1 vertebra were taken respectively. The angle of the two tangent lines was used as the lumbar kyphosis angle, and the measurement method of Cobb angle was used. The angle between the tangent line and horizontal line through the superior end plate of S1 vertebrae is obliquity angle of sacrum and measurement of angle. The measuring accuracy is 0.1 掳. The two groups of data were analyzed by Pearson correlation analysis and independent sample t-test. Results: the mean lumbar kyphosis angle was 31.4 掳卤11.3 掳, and the average sacral obliquity angle was 29.6 掳卤7.6 掳. The mean lumbar kyphosis angle was 30.8 掳卤5.4 掳and the average sacral angle was 27.6 掳卤2.0 掳in 10 patients with bilateral chorda muscle tension. The mean lumbar kyphosis angle was 31.6 掳卤12.5 掳and the average sacral inclination angle was 30.1 掳卤8.4 掳in other adolescent groups. The mean lumbar kyphosis angle was 37.9 掳卤7.2 掳, and the sacral inclination angle was 31.6 掳卤7.5 掳. The lumbar lordosis angle in the adolescent group was significantly lower than that in the middle aged control group (P 0.05), and the sacral obliquity angle in the adolescent group was also smaller than that in the middle and old age group, but there was no statistical difference between the two groups. Pearson correlation analysis showed that the sacral obliquity angle of the adolescent group was lower than that of the middle and old age group. Lumbar lordosis angle is closely related to sacral obliquity angle. Conclusion 1. The lumbar kyphosis angle of adolescent patients with lumbar disc herniation was significantly lower than that of middle and old patients. The curve of lumbar vertebrae tended to be perpendicular, and the vertical stress load of intervertebral disc and the shear stress load of posterior fibrous ring were heavier than those of middle and old patients. The lumbar kyphosis angle and sacral inclination angle of the adolescent intervertebral disc herniation patients with bilateral tension of rope muscle are smaller than those of other patients in the group, considering the pelvic retroversion caused by abnormal contraction of the cordineus muscle. At the same time, the secondary reduction of lumbar curvature, the causes of which need to be further studied. 3. The sacral obliquity angle of adolescent patients was smaller than that of the middle-aged group, but the difference was not significant. 4. Since the abnormal state of the human chorda may lead to vertical arrangement of the lumbar vertebrae and accelerate the process of intervertebral disc degeneration, we should focus on the prospective follow-up study in adolescents with bilateral tension of the rope muscles. The changes of lumbosacral sagittal position parameters and the pathological manifestations of disc degeneration were observed in order to clarify the importance of abnormal contraction of cordineus muscle in the pathogenesis of lumbar disc herniation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.53

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