MRI测量腰椎管狭窄症椎间盘退变和硬膜囊横截断面积的关系
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摘要
目的利用MRI影像探讨腰椎管狭窄症(LSS)患者椎间盘退变与硬膜囊横截断面积(DSCA)的关系。方法抽取91例中央型退行性腰椎管狭窄症患者作为LSS组,同时选取91例健康者作为对照组,利用MRI测量腰椎间盘退变和DSCA,根据Pfirrmann方法将椎间盘退变分为5级。结果 LSS组的椎间盘退变和年龄无相关性;两组的下腰椎重度退变椎间盘比例均高于L2/3节段,在L4/5、L5/S1节段的重度退变椎间盘比例,LSS组均比对照组高(P<0.05);重度退变椎间盘组和轻度退变椎间盘组的DSCA比较,LSS组仅在L2/3、L3/4差异有统计学意义,对照组在各节段无统计学差异。结论腰椎管狭窄症患者在L4/5、L5/S1节段椎间盘退变比正常人更严重,硬膜囊横截断面积和椎间盘退变无相关性,在L2/3、L3/4节段硬膜囊横截断面积随椎间盘退变严重而变小。
Objective To explore the relationship between lumbar disc degeneration (LDD) of lumbar spinal stenosis (LSS) and the dural sac cross-sectional area (DSCA) by MRI measurement.Methods 91 patients with central degenerative LSS were randomly selected and 91 age-and sex-matched people without LSS were selected as a control group.LDD was classified into five grades by MRI detection according to the method proposed by Pfirrmann and DSCA were measured.Results LDD was not associated with age in LSS.The proportion of severe degenerated disc in lower lumbar levels were higher than that of L2/3 in the two groups;DSCA in severe degenerated disc group was significantly smaller than that in light degenerated group only in L2/3 and L3/4 in LSS.There were no statistical differences in every lumbar level in the control group.Conclusions LDD in L4/5 and L5/S1 of LSS is more severe than that of the normal people.DSCA and LDD are positively correlated in L2/3 and L3/4,but not in L4/5 and L5/S1 for LSS.
Objective To explore the relationship between lumbar disc degeneration (LDD) of lumbar spinal stenosis (LSS) and the dural sac cross-sectional area (DSCA) by MRI measurement.Methods 91 patients with central degenerative LSS were randomly selected and 91 age-and sex-matched people without LSS were selected as a control group.LDD was classified into five grades by MRI detection according to the method proposed by Pfirrmann and DSCA were measured.Results LDD was not associated with age in LSS.The proportion of severe degenerated disc in lower lumbar levels were higher than that of L2/3 in the two groups;DSCA in severe degenerated disc group was significantly smaller than that in light degenerated group only in L2/3 and L3/4 in LSS.There were no statistical differences in every lumbar level in the control group.Conclusions LDD in L4/5 and L5/S1 of LSS is more severe than that of the normal people.DSCA and LDD are positively correlated in L2/3 and L3/4,but not in L4/5 and L5/S1 for LSS.
引文
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[13]吴剑宏,阮狄克.腰椎间盘退变的MRI诊断分级及其临床应用进展[J].中国脊柱脊髓杂志,2010,20(6):511-515.
[14]OISHI Y,SHIMIZU K,KATOH T,et al.Lack of association between lumbar disc degeneration and osteophyte formation in elderly japanese women with back pain[J].Bone,2003,32(4):405-411.
[15]FUJIWARA A,TAMAI K,AN H S,et al.The relationship between disc degeneration,facet joint osteoarthritis,and stability of the degenerative lumbar spine[J].J Spinal Disord,2000,13(5):444-450.
[16]蒋欣,MORISHITA Y,HENRY H,等.腰痛患者MRI上各节段腰椎间盘退变形式与年龄的相关性分析[J].中国脊柱脊髓杂志,2009,19(11):845-849.
[17]刘汝落.腰椎管狭窄症[J].中国矫形外科杂志,2004,12(19):72-74.
[18]崔涛,李书忠,张修塨,等.MRI影像测量腰椎黄韧带厚度与退变性椎间盘的关系[J].中国组织工程研究与临床康复,2011,15(9):1615-1618.2017-02-03
[2]ISSACK P S,CUNNINGHAM M E,PUMBERGER M,et al.Degenerative lumbar spinal stenosis:evaluation and management[J].J Am Acad Orthop Surg,2012,20(8):527-535.
[3]AHN T J,LEE S H,CHOI G,et al.Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading[J].Neurol Med Chir(Tokyo),2009,49(6):242-247.
[4]GENEVAY S,ATLAS S J.Lumbar spinal stenosis[J].Best Pract Res Clin Rheumatol,2010,24(2):253-265.
[5]ALTINKAYA N,YILDIRIM T,DEMIR S,et al.Factors associated with the thickness of the ligamentum flavum:is ligamentum flavum thickening due to hypertrophy or buckling?[J].Spine(Phila Pa 1976),2011,36(16):1093-1097.
[6]SIEBERT E,PRUSS H,KLINGEBIEL R,et al.Lumbar spinal stenosis:syndrome,diagnostics and treatment[J].Nat Rev Neurol,2009,5(7):392-403.
[7]刘湘,季伟,李伦超,等.中老年椎体骨赘和腰椎间盘退变的相关性[J].实用医学杂志,2016,32(7):1133-1136.
[8]付长林,张斌,刘远,等.腰痛患者腰椎小关节退变与椎间盘退变的MRI比较[J].中国组织工程研究,2015,19(46):7401-7405.
[9]BATTIE M C,ORTEGA-ALONSO A,NIEMELAINEN R,et al.Lumbar spinal stenosis is a highly genetic condition partly mediated by disc degeneration[J].Arthritis Rheumatol,2014,66(12):3505-3510.
[10]COOK D J,YEAGER M S,CHENG B C.Range of motion of the intact lumbar segment:a multivariate study of 42 lumbar spines[J].Int J Spine Surg,2015,9:5.
[11]TANAKA N,AN H S,LIM T H,et al.The relationship between disc degeneration and flexibility of the lumbar spine[J].Spine J,2001,1(1):47-56.
[12]PFIRRMANN C W,METZDORF A,ZANETTI M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine(Phila Pa 1976),2001,26(17):1873-1878.
[13]吴剑宏,阮狄克.腰椎间盘退变的MRI诊断分级及其临床应用进展[J].中国脊柱脊髓杂志,2010,20(6):511-515.
[14]OISHI Y,SHIMIZU K,KATOH T,et al.Lack of association between lumbar disc degeneration and osteophyte formation in elderly japanese women with back pain[J].Bone,2003,32(4):405-411.
[15]FUJIWARA A,TAMAI K,AN H S,et al.The relationship between disc degeneration,facet joint osteoarthritis,and stability of the degenerative lumbar spine[J].J Spinal Disord,2000,13(5):444-450.
[16]蒋欣,MORISHITA Y,HENRY H,等.腰痛患者MRI上各节段腰椎间盘退变形式与年龄的相关性分析[J].中国脊柱脊髓杂志,2009,19(11):845-849.
[17]刘汝落.腰椎管狭窄症[J].中国矫形外科杂志,2004,12(19):72-74.
[18]崔涛,李书忠,张修塨,等.MRI影像测量腰椎黄韧带厚度与退变性椎间盘的关系[J].中国组织工程研究与临床康复,2011,15(9):1615-1618.2017-02-03