国人腰椎骨密度与腰椎间盘退变的相关性研究

发布时间：2018-08-03 10:50

【摘要】：研究证实,四肢骨关节中骨关节炎和骨质疏松之间存在反向的相关关系:骨关节炎越严重,骨密度就越高,即骨质疏松的程度越轻。椎体骨质疏松和椎间盘退变是常见的脊柱疾患,然而腰椎骨密度与腰椎间盘之间的确切关系迄今仍然存在着广泛争议。既往研究多认为腰椎骨密度越高,腰椎间盘退变越严重;相反地,也有研究发现骨质疏松患者更可能出现腰椎间盘退变。腰椎骨密度与腰椎间盘退变的相关性研究受到骨密度测量的部位和技术、椎间盘退变的测量方法以及研究对象等诸多因素的影响。明确腰椎骨密度和腰椎间盘退变的相关关系,对于理解脊柱疾患,特别是老年性脊柱疾患的病因、发生、发展过程有重要的理论意义。目的:探讨不同人群腰椎骨密度与腰椎间盘退变的相关关系。方法:本研究选取2012年1月至2015年9月期间,在浙一医院因腰腿疼痛就诊的165例腰椎疾患病人、在邵逸夫医院常规体检的161例体检者以及来自杭州采荷社区的186例志愿者,所有入选样本均有腰椎磁共振(MR)和DXA腰椎骨密度检查。其中,186例社区志愿者同时测量了髋部骨密度。在腰椎MRT2像,Pfirrmann 5级评分法评估腰椎间盘退变、改良的Weishaupt3级评分法评估关节突关节退变。多因素回归分析不同人群骨密度与年龄、性别、体重指数、腰椎区域、关节突关节退变以及腰椎间盘退变的相关关系。结果:本研究共纳入512例样本。腰椎疾患组165例,其中男性30例,女性135例,年龄49～102岁,平均69.9±8.7岁;体检组161例,其中男性117例,女性44例,年龄31～76岁,平均48.8±8.6岁;社区志愿者组186例,其中男性109例,女性77例,年龄24～87岁,平均50.8±15.5岁。体检组和社区志愿者组在年龄、性别比例以及腰椎骨密度均无明显差异,因此将两组合并为"一般人群组"。单因素分析显示,年龄越大,腰椎间盘退变(Coef.=0.03,P0.01)和关节突关节退变(Coef.=0.01,P0.01)越严重。腰椎间盘退变与关节突关节退变呈正相关(Coef.=0.26,P0.01)。在腰椎疾患组和一般人群组中,腰椎骨密度与年龄均呈负相关(腰椎疾患组Coef.=-0.02,P0.01;一般人群组Coef.=-0.04,P0.01),与体重指数均呈正相关(腰椎疾患组 Coef.=0.01,P0.01;一般人群组 Coef.=0.01,P0.01)。在一般人群组中,多因素分析纳入年龄、性别、体重指数和腰椎区域后发现:腰椎骨密度与严重的腰椎间盘退变(Pfirrmann评分为V)呈正相关关系(Coef.=0.26,P0.05);进一步将关节突关节退变纳入多因素回归,腰椎骨密度与腰椎间盘退变的相关关系消失(P0.05),而与关节突关节退变呈正相关(Coef.=0.12,P0.01)。在腰椎疾患组中,腰椎骨密度与腰椎间盘之间未见统计学相关关系(P0.05)。在186例有髋部骨密度的一般人群中,髋部骨密度与腰椎间盘退变之间无相关关系(P0.05)。结论:本研究未观察到腰椎骨密度与腰椎间盘退变之间存在相关关系,骨密度可能不是腰椎间盘退变的危险因素。关节突关节退变干扰腰椎骨密度的测量,可能混淆腰椎骨密度与腰椎间盘退变的相关关系。
[Abstract]:The study confirms that there is a reverse correlation between osteoarthritis and osteoporosis in the extremities: the more severe osteoarthritis, the higher the bone density, the less the degree of osteoporosis. Vertebral osteoporosis and disc degeneration are common spinal disorders, but the exact relationship between the bone density of the lumbar spine and the lumbar intervertebral disc still remains. The higher the bone density of the lumbar spine, the more severe the lumbar intervertebral disc degeneration; on the contrary, the study found that the patients with osteoporosis are more likely to have lumbar disc degeneration. The correlation between the lumbar bone density and lumbar disc degeneration is studied by the site and technique of the measurement of bone density, and the method of measuring the degeneration of the intervertebral disc. The relationship between lumbar bone density and lumbar intervertebral disc degeneration has important theoretical significance for understanding the etiology, occurrence and development of spinal disorders, especially for senile spinal disorders. Objective: To explore the relationship between lumbar bone density and lumbar intervertebral disc degeneration in different groups. From January 2012 to September 2015, 165 patients with lumbar disease were diagnosed with lumbago and leg pain in Zhejiang one hospital. 161 cases of routine physical examination in Sir Run Run Shaw Hospital and 186 volunteers from Hangzhou mining community were selected. All the selected samples were examined by lumbar magnetic resonance (MR) and DXA lumbar bone density examination. Among them, 186 cases of community volunteering were voluntary. The bone mineral density of the hip was measured at the same time. The lumbar MRT2 image, Pfirrmann 5 grade evaluation was used to evaluate the lumbar intervertebral disc degeneration, and the improved Weishaupt3 grade evaluation was used to evaluate the articular process degeneration. Results: 512 samples were included in this study. There were 165 cases in the lumbar disease group, including 30 males and 135 females, 49~102 years old and 69.9 8.7 years old, and 161 cases in the physical examination group, including 117 men, 44 women, 31~76 years of age, and average 48.8 + 8.6 years. .8 + 15.5 years old. There was no significant difference in age, sex ratio and lumbar bone mineral density in the physical examination group and the community volunteer group. Therefore, the two groups were merged into the "general population group". Single factor analysis showed that the older the age, the more severe the lumbar intervertebral disc degeneration (Coef.=0.03, P0.01) and the articular process (P0.01) were more serious. The lumbar disc degeneration and joint process were more serious. The joint degeneration was positive correlation (Coef.=0.26, P0.01). In the lumbar disease group and the general population group, the lumbar bone density was negatively correlated with age (Coef.=-0.02, P0.01, Coef.=-0.04, P0.01) in the lumbar disease group (Coef.=-0.04, P0.01), and was positively correlated with the body mass index (Coef.=0.01, P0.01; Coef.=0.01, P0.01) in the general group. In the population group, multifactor analysis was included in age, sex, body mass index and lumbar region: the lumbar bone density was positively correlated with the severe lumbar disc degeneration (Pfirrmann score V) (Coef.=0.26, P0.05), and the regression of the articular process was further included in the regression of the multifactorin, and the correlation between the lumbar bone density and the lumbar disc degeneration was related. There was a positive correlation between the loss of (P0.05) and articular process degeneration (Coef.=0.12, P0.01). In the lumbar disease group, there was no statistical correlation between the lumbar bone density and the lumbar intervertebral disc (P0.05). There was no correlation between the hip bone density and the lumbar disc degeneration (P0.05) in 186 cases with hip bone density (P0.05). Conclusion: This study was not observed. There is a correlation between lumbar bone density and lumbar intervertebral disc degeneration. Bone density may not be a risk factor for lumbar intervertebral disc degeneration. The measurement of lumbar intervertebral bone density interfered with articular process degeneration may confuse the correlation between lumbar bone density and lumbar disc degeneration.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.5

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