健康成人腰椎椎间隙高度的解剖学分型及临床意义
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摘要
目的观察健康成年人腰椎椎间隙高度变化及对于不同高度的解剖学分型。方法选取行脊柱全长片及腰椎磁共振志愿者169例,测量L_(1/2)、L_(2/3)、L_(3/4)、L_(4/5)、L_5/S_1椎间隙高度(H1～H5)及L_1～L_5椎体高度,分析男女志愿者各椎间隙绝对高度及相对高度(该椎间隙高度/上位椎体高度,H1/L1～H5/L_5),以及各类型椎间隙高度人群数量分布。结果椎间隙高度及相对椎间隙高度均随结构位置的降低逐渐增加,在L_(4/5)达到最大值,相邻椎间隙高度差异有统计学意义(P<0.05)。而同一组椎间隙高度中,男女间差异无统计学意义(P>0.05),L_(4/5)椎间隙测量中有11.83%志愿者(20/169例)有高椎间隙的表现。在H1/L_1组中有66.67%男性志愿者属于相对低间隙组(56/84例),在H2/L_2～H5/L_5组中有75.15%(127/169例)、73.96%(125/169例)、71.01%(120/169例)、65.68%(111/169例)相对椎间隙高度比在0.4～0.5之间,而在H3/L_3、H4/L_4、H5/L_5组中有8.28%(17/169例)、23.67%(40/169例)、8.28%(17/169例)属于相对高间隙组。结论 L_(4/5)椎间隙高度在健康成人腰椎椎间隙高度中最高,健康成人腰椎椎间隙高度差异大,对椎间隙高度的解剖学分型具有一定临床意义。
Objective To observe the changes of lumbar intervertebral space heights in healthy adults and the anatomical classification of different heights. Methods A total of 169 volunteers who received full-length spine and lumbar magnetic resonance in our hospital were involved. The L_(1/2), L_(2/3), L_(3/4), L_(4/5), L_5/S_1 intervertebral space heights(H1-H5) and L_1-L_5 vertebral height were measured to analyze the absolute height and relative height of each intervertebral space in male and female volunteers(the height of the intervertebral space/upper vertebral height, H1/L_1-H5/L_5) and the distribution of various types of intervertebral space. Results Both of the height and relative height of intervertebral space increased gradually with the decrease of the structural position at L_(4/5), and the difference between the heights of adjacent intervertebral space was statistically significant(P<0.05). There was no significant difference between male and female in the same intervertebral space(P>0.05). In the L_(4/5) intervertebral space measurement, 11.83% volunteers(20/169) had high intervertebral space. In the H1/L_1 intervertebral space measurement, 66.67% male volunteers had relatively low space(56/84). In the H2/L_2-H5/L_5 intervertebral space measurement, 75.15%(127/169), 73.96%(125/169), 71.01%(120/169), 65.68%(111/169) volunteers had relative intervertebral space height ratio of 0.4-0.5. In the H3/L_3, H4/L_4, and H5/L_5 intervertebral space measurement, 8.28%(17/169), 23.67%(40/169), 8.28%(17/169) volunteers had relatively high space. Conclusion The L_(4/5) intervertebral space height is the highest in the lumbar intervertebral space of healthy adults. There is significant difference in the height of lumbar intervertebral space among healthy adults. The anatomical classification of intervertebral space height has clinical significance.
Objective To observe the changes of lumbar intervertebral space heights in healthy adults and the anatomical classification of different heights. Methods A total of 169 volunteers who received full-length spine and lumbar magnetic resonance in our hospital were involved. The L_(1/2), L_(2/3), L_(3/4), L_(4/5), L_5/S_1 intervertebral space heights(H1-H5) and L_1-L_5 vertebral height were measured to analyze the absolute height and relative height of each intervertebral space in male and female volunteers(the height of the intervertebral space/upper vertebral height, H1/L_1-H5/L_5) and the distribution of various types of intervertebral space. Results Both of the height and relative height of intervertebral space increased gradually with the decrease of the structural position at L_(4/5), and the difference between the heights of adjacent intervertebral space was statistically significant(P<0.05). There was no significant difference between male and female in the same intervertebral space(P>0.05). In the L_(4/5) intervertebral space measurement, 11.83% volunteers(20/169) had high intervertebral space. In the H1/L_1 intervertebral space measurement, 66.67% male volunteers had relatively low space(56/84). In the H2/L_2-H5/L_5 intervertebral space measurement, 75.15%(127/169), 73.96%(125/169), 71.01%(120/169), 65.68%(111/169) volunteers had relative intervertebral space height ratio of 0.4-0.5. In the H3/L_3, H4/L_4, and H5/L_5 intervertebral space measurement, 8.28%(17/169), 23.67%(40/169), 8.28%(17/169) volunteers had relatively high space. Conclusion The L_(4/5) intervertebral space height is the highest in the lumbar intervertebral space of healthy adults. There is significant difference in the height of lumbar intervertebral space among healthy adults. The anatomical classification of intervertebral space height has clinical significance.
引文
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[13]龚克.正常人群腰椎椎间高度指数、椎间角度、腰椎前凸角的研究分析及椎间高度指数与椎间盘Pfirrmann分级的相关性研究[D].西安:空军军医大学,2018.
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[15]Allaire BT,DePaolis Kaluza MC,Bruno AG,et al.E-valuation of a new approach to compute intervertebral disc height measurements from lateral radiographic view s of the spine[J].European spine journal,2017,26(1):167-172.
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[17]刘耀升,陈其昕,廖胜辉,等.椎间盘高度降低及退变对腰椎生物力学影响的有限元分析[J].中国临床解剖学杂志,2006,24(5):566-570.LIU Yaosheng,CHEN Qixin,LIAO Shenghui,et al.The effect of disc height and degeneration on th mechanical behavior of lumbar spine:a finite element analysis[J].Chinese Journal Of Clinical Anatomy,2006,24(5):566-570.
[18]Teichtahl AJ,Urquhart DM,Wang Y,et al.A Dose-response relationship betw een severity of disc degeneration and intervertebral disc height in the lumbosacral spine[J].Arthritis Res Ther,2015,17:297.doi:10.1186/s13075-015-0820-1.
[19]Sebaaly A,Grobost P,Mallam L,et al.Description of the sagittal alignment of the degenerative human spine[J].Eur Spine J,2018,27(2):489-496.
[20]Vodi■ar M,Ko■ak R,Goren■ek M,et al.Vertebral endplate perforation for intervertebral disc height preservation after single-level lumbar discectomy:a randomizedcontrolled trial[J].Clin Spine Surg,2017,30(6):707-712.
[21]杨璐,邢浩然,陈晶晶,等.腰椎间盘退变时椎间盘高度变化及其临床意义[J].中国临床解剖学杂志,2017,35(3):355-358.YANG Lu,XING Haoran,CHEN Jingjing,et al.Change of intervertebral disc height during degeneration and its clinical significance[J].Chinese Journal of Clinical Anatomy,2017,35(3):355-358.
[22]Laouissat F,Sebaaly A,Gehrchen M,et al.Classification of normal sagittal spine alignment:refounding the Roussouly classification[J].Eur Spine J,2018,27(8):2002-2011.
[23]Cheng X,Zhang F,Zhang K,et al.Effect of single-level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients w ith lumbar degenerative disease[J].World Neurosurg,2018,109:244-251.doi:10.1016/j.w neu.2017.09.154.
[24]Zhong W,Driscoll SJ,Tsai TY,et al.In vivo dynamic changes of dimensions in the lumbar intervertebral foramen[J].Spine J,2015,15(7):1653-1659.
[25]Zhao X,Du L,Xie Y,et al.Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion:a finite element analysis[J].World Neurosurg,2018,114:114-120.doi:10.1016/j.w neu.2018.02.073.
[2]Paholpak P,Wang Z,Sakakibara T,et al.An increase in height of spinous process is associated w ith decreased heights of intervertebral disc and vertebral body in the degenerative process of lumbar spine[J].Eur Spine J,2013,22(9):2030-2034.
[3]吴建锋,贾连顺,李家顺,等.腰椎MRI间盘信号及高度的改变与椎间盘源性腰痛的相关性研究[J].中国医疗前沿,2009,4(1):1-3.WU Jianfeng,JIA Lianshun,LI Jiashun,et al.The correlation study of the signal and height of the M RI for the lumbar disc and the discogenic low back pain[J].China Healthcare Frontiers,2009,4(1):1-3.
[4]王晓东,马丽,王德洪,等.60-69岁老年人腰椎椎间隙高度与慢性腰痛的相关性研究[J].中国运动医学杂志,2013,32(6):540-544.
[5]Cinotti G,De Santis P,Nofroni I,et al.Stenosis of lumbar intervertebral foramen:anatomic study on predisposing factors[J].Spine,2002,27(3):223-229.
[6]Morishita Y,Masuda M,Maeda T,et al.Morphologic Evaluation of Lumbosacral Nerve Roots in the Vertebral Foramen:M easurement of Local Pressure of the Intervertebral Foramen[J].Clinical Spine Surgery,2017,30(6):839-844.
[7]Yan S,Zhang Y,Wang K,et al.Three-dimensional morphological characteristics of low er lumbar intervertebral foramen w ith age[J].Biomed Res Int,2018,2018,8157061.doi:10.1155/2018/8157061.
[8]Teichtahl AJ,Urquhart DM,Wang Y,et al.Modic changes in the lumbar spine and their association w ith body composition,fat distribution and intervertebral disc height-a 3.0 T-M RI study[J].BM C musculoskeletal disorders,2016,17:92.doi:10.1186/s12891-016-0934-x.
[9]Barrey C,Roussouly P,Le Huec JC,et al.Compensatory mechanisms contributing to keep the sagittal balance of the spine[J].European spine journal,2013,22(Suppl 6):834-841.
[10]赵亮,瞿东滨,金大地.正常人腰椎间盘的MRI测量及其临床意义[J].中国脊柱脊髓杂志,2003,13(4):241-243.ZHAO Liang,QU Dongbin,JIN Dadi.M RI measurement of lumbar disc in normal adult and its clinical significance[J].Chinese Journal of Spine and Spinal Cord,2003,13(4):241-243.
[11]Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J].Spine,2005,30(3):346-353.
[12]Zhang F,Zhang K,Tian HJ,et al.Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults[J].J Orthop Surg Res,2018,13(1):34.
[13]龚克.正常人群腰椎椎间高度指数、椎间角度、腰椎前凸角的研究分析及椎间高度指数与椎间盘Pfirrmann分级的相关性研究[D].西安:空军军医大学,2018.
[14]Bach K,Ford J,Foley R,et al.Morphometric Analysis of Lumbar Intervertebral Disc Height:An Imaging Study[J].World Neurosurg,2018,20:1878-8750.doi:10.1016/j.w neu.
[15]Allaire BT,DePaolis Kaluza MC,Bruno AG,et al.E-valuation of a new approach to compute intervertebral disc height measurements from lateral radiographic view s of the spine[J].European spine journal,2017,26(1):167-172.
[16]Menezes-Reis R,Bonugli GP,Dalto VF,et al.Association betw een lumbar spine sagittal alignment and L4-L5disc degeneration among asymptomatic young adults[J].Spine,2016,41(18):1081-1087.
[17]刘耀升,陈其昕,廖胜辉,等.椎间盘高度降低及退变对腰椎生物力学影响的有限元分析[J].中国临床解剖学杂志,2006,24(5):566-570.LIU Yaosheng,CHEN Qixin,LIAO Shenghui,et al.The effect of disc height and degeneration on th mechanical behavior of lumbar spine:a finite element analysis[J].Chinese Journal Of Clinical Anatomy,2006,24(5):566-570.
[18]Teichtahl AJ,Urquhart DM,Wang Y,et al.A Dose-response relationship betw een severity of disc degeneration and intervertebral disc height in the lumbosacral spine[J].Arthritis Res Ther,2015,17:297.doi:10.1186/s13075-015-0820-1.
[19]Sebaaly A,Grobost P,Mallam L,et al.Description of the sagittal alignment of the degenerative human spine[J].Eur Spine J,2018,27(2):489-496.
[20]Vodi■ar M,Ko■ak R,Goren■ek M,et al.Vertebral endplate perforation for intervertebral disc height preservation after single-level lumbar discectomy:a randomizedcontrolled trial[J].Clin Spine Surg,2017,30(6):707-712.
[21]杨璐,邢浩然,陈晶晶,等.腰椎间盘退变时椎间盘高度变化及其临床意义[J].中国临床解剖学杂志,2017,35(3):355-358.YANG Lu,XING Haoran,CHEN Jingjing,et al.Change of intervertebral disc height during degeneration and its clinical significance[J].Chinese Journal of Clinical Anatomy,2017,35(3):355-358.
[22]Laouissat F,Sebaaly A,Gehrchen M,et al.Classification of normal sagittal spine alignment:refounding the Roussouly classification[J].Eur Spine J,2018,27(8):2002-2011.
[23]Cheng X,Zhang F,Zhang K,et al.Effect of single-level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients w ith lumbar degenerative disease[J].World Neurosurg,2018,109:244-251.doi:10.1016/j.w neu.2017.09.154.
[24]Zhong W,Driscoll SJ,Tsai TY,et al.In vivo dynamic changes of dimensions in the lumbar intervertebral foramen[J].Spine J,2015,15(7):1653-1659.
[25]Zhao X,Du L,Xie Y,et al.Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion:a finite element analysis[J].World Neurosurg,2018,114:114-120.doi:10.1016/j.w neu.2018.02.073.