歼击机飞行员胸腰段椎体楔形变与腰椎间盘突出症的相关性分析
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摘要
目的明确歼击机飞行员胸腰段椎体楔形变与腰椎间盘突出症是否相关。方法选取2006年—2010年因腰椎间盘突出症在空军特色医学中心(原空军总医院)住院治疗的38例歼击机飞行员作为观察组。根据年龄分层随机选取同期来院改装体检的40名健康歼击机飞行员作为对照组,2组再根据有无楔形变将分为楔形变亚组和无楔形变亚组。采用脊柱X线分析软件在腰椎侧位片上测量并计算T11-L1椎体前后缘高度比,胸腰段后凸角和腰椎前凸角。测量腰椎核磁轴位像上突出物最大矢状径,并记录椎间盘突出节段数。结果观察组胸腰段椎体楔形变发生率、楔形变椎体数量、椎体楔形变程度与对照组比较,差异无统计学意义(P>0.05);2组楔形变椎体前后缘高度比无统计学差异(P>0.05)。观察组中楔形变亚a组比无楔形变亚a组胸腰段后凸角大(P<0.05),而2个亚组间腰椎前凸角、椎间盘突出节段数和突出物最大矢状径比较差异无统计学意义(P>0.05)。对照组中楔形变亚b组比无楔形变亚b组胸腰段后凸角大(P<0.05);2个亚组间腰椎前凸角比较差异无统计学意义(P>0.05)。结论歼击机飞行员胸腰段椎体楔形变对腰椎间盘突出症可能没有力学影响。
Objective To find the correlations between the wedeged thoracolumabar ver tebrae(WTV) and lumbar disc herniation(LDH) in fighter pilots. Methods Thirty-eight fighter aviators hospitalized in Air Force Medical Center between 2006 and 2010 due to LDH served as the observation group. Another group of 40 healthy fighter pilots randomly chosen from pilots for the annual physical examination during the same period was assigned to the control group, whose age marched that of the observation group. Both groups were divided into the WTV subgroup and non-WTV subgroup.Erect lateral lumbar X-ray was analyzed with the spine x-ray analysis system. The anterior and posterior heights of T11-L1 vertebrae were measured before the ratio of the anterior height to the posterior height was calculated. The thoracolumbar kyphosis angle(TLKA) and lumbar lordosis angle(LLA) were also measured. The maximum sagittal diameter of protruded discs in axial view of MRI was measured and the number of protruded discs was recorded. Results There was no significant difference in the incidence of WTV, number of WTV, and ratio of the anterior height to the posterior height in WTV between the observation group and control group(P>0.05). In the observation group, the TLKA in the WTV subgroup was bigger than that in the non-WTV subgroup(P<0.05), but there was no significant difference in the LLA, number of protruded discs and maximum sagittal diameter of protruded discs between the two subgroups(P>0.05). In the control group, the TLKA in the WTV subgroup was also bigger than that in the non-WTV group(P<0.05), but there was no significant difference in the LLA between the two subgroups(P>0.05). Conclusion The wedeged thoracolumabar vertebrae may have no biomechanical effect on lubar disc herniation in fighter pilots.
Objective To find the correlations between the wedeged thoracolumabar ver tebrae(WTV) and lumbar disc herniation(LDH) in fighter pilots. Methods Thirty-eight fighter aviators hospitalized in Air Force Medical Center between 2006 and 2010 due to LDH served as the observation group. Another group of 40 healthy fighter pilots randomly chosen from pilots for the annual physical examination during the same period was assigned to the control group, whose age marched that of the observation group. Both groups were divided into the WTV subgroup and non-WTV subgroup.Erect lateral lumbar X-ray was analyzed with the spine x-ray analysis system. The anterior and posterior heights of T11-L1 vertebrae were measured before the ratio of the anterior height to the posterior height was calculated. The thoracolumbar kyphosis angle(TLKA) and lumbar lordosis angle(LLA) were also measured. The maximum sagittal diameter of protruded discs in axial view of MRI was measured and the number of protruded discs was recorded. Results There was no significant difference in the incidence of WTV, number of WTV, and ratio of the anterior height to the posterior height in WTV between the observation group and control group(P>0.05). In the observation group, the TLKA in the WTV subgroup was bigger than that in the non-WTV subgroup(P<0.05), but there was no significant difference in the LLA, number of protruded discs and maximum sagittal diameter of protruded discs between the two subgroups(P>0.05). In the control group, the TLKA in the WTV subgroup was also bigger than that in the non-WTV group(P<0.05), but there was no significant difference in the LLA between the two subgroups(P>0.05). Conclusion The wedeged thoracolumabar vertebrae may have no biomechanical effect on lubar disc herniation in fighter pilots.
引文
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[7]陈仲强,党耕町,郭昭庆,等.胸腰段僵硬性角状后凸畸形对下腰椎的影响及外科治疗[J].中华外科杂志,2000,38(11):824-826.
[8]冯宇,郭伟,孙鹏,等.青少年胸12腰1段椎体楔形变在下腰椎间盘退变发病中的意义[J].颈腰痛杂志,2005,26(2):131.
[9]Bruno AG,Burkhart K,Allaire B,et al.Spinal Loading Patterns From Biomechanical Modeling Explain the High Incidence of Vertebral Fractures in the Thoracolumbar Region[J].J Bone Miner Res,2017,32(6):1 282-1 290.
[2]胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2005:594.
[3]冯天有.中西医结合治疗软组织损伤[M].北京:人民卫生出版社,1977:17.
[4]Bruno AG,Anderson DE,D'Agostino J,et al.The effect of thoracic kyphosis and sagittal plane alignment on vertebral compressive loading[J].J Bone Miner Res.2012,27(10):2 144-2 151.
[5]Galbusera F,Brayda-Bruno M,Costa F,et al.Numerical evaluation of the correlation between the normal variation in the sagittal alignment of the lumbar spine and the spinal loads[J].J Orthop Res,2014,32(4):537-544.
[6]吉立新,陈仲强.胸腰段后凸畸形对腰椎前凸角度的影响及其临床意义[J].中国矫形外科杂志.2003,11(17):1 165-1 166.
[7]陈仲强,党耕町,郭昭庆,等.胸腰段僵硬性角状后凸畸形对下腰椎的影响及外科治疗[J].中华外科杂志,2000,38(11):824-826.
[8]冯宇,郭伟,孙鹏,等.青少年胸12腰1段椎体楔形变在下腰椎间盘退变发病中的意义[J].颈腰痛杂志,2005,26(2):131.
[9]Bruno AG,Burkhart K,Allaire B,et al.Spinal Loading Patterns From Biomechanical Modeling Explain the High Incidence of Vertebral Fractures in the Thoracolumbar Region[J].J Bone Miner Res,2017,32(6):1 282-1 290.