腰椎间盘高度降低与其椎间盘退行性变的相关性研究
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摘要
目的：运用Frobin的腰椎间盘高度测量方法—失真-补偿X线测量法(Distortion-compensated roentgen analysis，DCRA)以及磁共振技术，从影像学上探讨人体腰椎间盘高度降低与其椎间盘退行性变的相互关系以及两者出现的先后次序问题。方法：1、用DCRA法测量63例，共187个正常腰椎间盘(腰3～骶1水平)的高度值以及前弓弧度值，其中男性32例，平均年龄35岁；女性31例，平均年龄31岁。按相同性别，相同椎间盘水平分组，并求出它们的平均高度值及平均腰椎前弓弧度值，作为正常对照值。2、用DCRA法测量38例患有腰痛的病人，总共111个腰椎间盘(腰3～骶1水平)的高度及前弓弧度值，其中男性20例，女性18例，平均年龄自50岁，并将所测高度值用正常对照组中相同性别、相同椎间盘水平的平均高度值及平均腰椎前弓弧度值加以校正。3、应用磁共振技术(T2加权像)采用双盲法对这38例腰痛病人的总共111个腰椎间盘按照退行性变的程度进行分组。主要根据椎间盘髓核信号的强度变化以及有无突出情况将这些椎间盘分成A～F组。4、用统计学方法(t检验)比较各组中的腰椎间盘平均高度值(校正后)与正常人群之间的差异，显著差异水平定为0.05。结果：1、A组(没有髓核信号变化，也没有椎间盘突出)及C组(髓核信号轻至中度减低，不伴有椎间盘突出)其腰椎间盘平均高度值与正常人群对比没有显著差异(P＞0.05)。2、D组(髓核信号轻至中度减低并伴有椎间盘突出)及F组(髓核信号消失并伴有椎间盘突出)其腰椎间盘平均高度值与正常人群对比有极显著差异(P＜0.01)3．各组内各个椎间盘之间的变异度较大。结论：1．腰椎间盘的退行改变与腰椎间盘高度之间有着密切联系。2．腰椎间盘的退行性变先于腰椎间盘高度的降低。3．腰椎间盘高度的降低出现于腰椎间盘退行性交的后期，退变早期不伴有高度降低。4．因各组内各个椎间盘的高度变异度较大，临床上应注意个体间的差异。
objective: Applying Frobin's method of measuring the intervertebral disk height, distortion-compensated roentgen analysis(DCRA), and magnetic resonance imaging to discuss the relationship between degeneration of disk tissue and the height loss of disks, and their occurring sequence of the human lumber spine. Methods:1. Apply the method of DCRA to measure the height of 187 intervertebral disks(level:L3 ~ S1), from 63 normal cases, in which, 32men(mean age 35 years), 31women(mean age 33 years). Categories are selected according to the same sex, and same level of disks, and their mean height and mean angle of lordosis of each category are calculated. These values serves as of control group. 2. Applying the method of DCRA to measure the height and the angle of lordosis of the 111 intervertebral disks(level:L3 - S1)from 38 subjects suffering with lower back pain in which 20 men, 18 women, age 19- 78 yeas, and then to correct the each value measured by the mean height and mean angle of lordosis of the control group according to the same sex, same level of disks. 3. Classifying these 111 intervertebral disks of 38 subjects suffering with lower back pain, according to the situation of degenerative changes of these disks on magnetic resonance imaging(T2-weighted, sagittal). Group A~ F are categorized according to the signal change of the nucleus pulposus with or without prolapse. 4.To contrast the mean height(after correction)of each group(A - F)with that of the normal population by the t-test. The level of significance was set to 0.05. Results: 1. The mean disks height in Group A (no signal change, no prolapse, total 32 disks) and group C(moderate signal loss, prolapse, total 23 disks) dose not significantly differ from that of normal(P>0.05). 2.The mean disk height in group D(moderate signal loss, prolapse, total 35 disks)and group F(total signal loss, prolapse, total 15 disks)deviate significantly from that of normal(p<0.01). 3.In each group (A - F)disk height exhibits considerable variation.
Conclusion: 1.Lumbar disk degeneration and disk height loss correlate considerably. 2.Lumbar disk degeneration precedes the disk height loss. 3. Lumbar disk height loss occurs in the late stage of disk degeneration, in early stage , no disk height loss. 4. Considering the disk height variation in each group , we should pay more attention to individual variation clinically.
objective: Applying Frobin's method of measuring the intervertebral disk height, distortion-compensated roentgen analysis(DCRA), and magnetic resonance imaging to discuss the relationship between degeneration of disk tissue and the height loss of disks, and their occurring sequence of the human lumber spine. Methods:1. Apply the method of DCRA to measure the height of 187 intervertebral disks(level:L3 ~ S1), from 63 normal cases, in which, 32men(mean age 35 years), 31women(mean age 33 years). Categories are selected according to the same sex, and same level of disks, and their mean height and mean angle of lordosis of each category are calculated. These values serves as of control group. 2. Applying the method of DCRA to measure the height and the angle of lordosis of the 111 intervertebral disks(level:L3 - S1)from 38 subjects suffering with lower back pain in which 20 men, 18 women, age 19- 78 yeas, and then to correct the each value measured by the mean height and mean angle of lordosis of the control group according to the same sex, same level of disks. 3. Classifying these 111 intervertebral disks of 38 subjects suffering with lower back pain, according to the situation of degenerative changes of these disks on magnetic resonance imaging(T2-weighted, sagittal). Group A~ F are categorized according to the signal change of the nucleus pulposus with or without prolapse. 4.To contrast the mean height(after correction)of each group(A - F)with that of the normal population by the t-test. The level of significance was set to 0.05. Results: 1. The mean disks height in Group A (no signal change, no prolapse, total 32 disks) and group C(moderate signal loss, prolapse, total 23 disks) dose not significantly differ from that of normal(P>0.05). 2.The mean disk height in group D(moderate signal loss, prolapse, total 35 disks)and group F(total signal loss, prolapse, total 15 disks)deviate significantly from that of normal(p<0.01). 3.In each group (A - F)disk height exhibits considerable variation.
Conclusion: 1.Lumbar disk degeneration and disk height loss correlate considerably. 2.Lumbar disk degeneration precedes the disk height loss. 3. Lumbar disk height loss occurs in the late stage of disk degeneration, in early stage , no disk height loss. 4. Considering the disk height variation in each group , we should pay more attention to individual variation clinically.
引文
[1] Yu S, Haughton VM, Ho PSP, et al. Progressive and regressive changes in the nucleus pulposus. Part Ⅱ: the adult. Radiology 1988;169:93～97
[2] Pope MH, Hanley EN, Matteri RE, et al. Measurement of intervertebral disc space height .Spine 1977; 2:282～286
[3] Andersson GBJ, Schultz A, Nathan A, et al. Roentgenographic measurement of the lumbar intervertebral disc height. Spine 1981;6:154～158
[4] Tibrewal SB, Pearcy MJ. Lumbar intervertebral disc heights in normal subjects and patients with disc herniation. Spine 1985;10:452～454
[5] Saraste H, Brostrom LA, Aparisi T, et al. Radiographic measurement of the lumbar spine: A clinical and experimental study in man. Spine 1985;10:236～241
[6] Frobin W, Brinckmann P, Biggemann M ,et al. Precision measurement of disc height ,vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech 1997; 12(suppl ): S1～63
[7] Frobin W, Brinckmann P, Kramer M, et al. Height of lumbar discs measureed from radiographs compared with degeneration and height classified from MR images. Eur. Radiol. 2001; 11:263～269
[8] 刘正津 陈尔瑜．临床解剖学丛书(胸部和脊柱分册)人民卫生出版社1989；P321～325
[9] Hurxthal L, Measurement of anterior vertebral compressions and biconcave vertebrae. J Am Radial 1968; 103: 35～644
[10] Modic MT, Pavlicek W ,Weinstein M, et al. Magnetic resonance imaging of intervertebral disk disease .Radiology 1984;152;103～111
[11] Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease .Radiology 1988;168:177～186
[12] Yu S, Hanghton VM,Sother LA, et al. Criteria for classifying normal and degenerated lumbar intervertebral disks. Radiology 1989;170:523～526
[13] Erkintalo MO, Salminen JJ, Alanen AM, et al. Development of degenerative changes in the lumber intervertebral disk: results of a prospective MR imaging study in adolescents with and without low-back pain. Radiology 1995;196:529～533
[14] Gries NC. Berlemann U, Moore RJ, et al. Earlyhistologic changes in lower lumbar discs and facet joints and their correlation .Eur Spine J 2000; 9:23～29
[15] 村田雅明 人腰椎间盘的MRI和组织生化学比较[日]国外医学 临床放射学分册1995；1：52
[16] Tertti M, Paajanen H, Laato M, et al. Disc degeneretion in magnetic resonance imaging: a comparative biochemical, histologic and radiologic study in cadaver spines .Spine 1991;16(6) 629～634
[17] Miller J.A.A, Schmatz C. BS, Schultz A.B. Lumbar disc degeneration: correlation with age ,sex and spine level in 600 autopsy specimens .Spine 1988;13(2):173～178
[18] Ho PSP, Yu S, Sether LA, et al. Progressive and regressive changes in the nucleus pulposus. Part Ⅰ: the neonate. Radiology 1988;169:87～91
[19] 江浩 骨与关节MRI 上海科学技术出版社．上海1999：48～58
[20] Modic MT. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166:193～199
[21] Deroos A. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disc disease. AJR 1987; 149:531～534
[22] 李果珍 临床CT诊断学 中国科学技术出版社 北京 1994：654～663
[23] 金丕焕 医用统计方法 上海医科大学出版社 上海 1993：15～44
[24] 尚铁松 王云钊 腰椎间盘退变的X线、MRI表现与病理对照 中华
放射学杂志 2002：36(9)：828～832
[25] Berlemann U, Gries N.C, Moore R.J .The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs, Eur Spine J 1998; 7:712～217
[2] Pope MH, Hanley EN, Matteri RE, et al. Measurement of intervertebral disc space height .Spine 1977; 2:282～286
[3] Andersson GBJ, Schultz A, Nathan A, et al. Roentgenographic measurement of the lumbar intervertebral disc height. Spine 1981;6:154～158
[4] Tibrewal SB, Pearcy MJ. Lumbar intervertebral disc heights in normal subjects and patients with disc herniation. Spine 1985;10:452～454
[5] Saraste H, Brostrom LA, Aparisi T, et al. Radiographic measurement of the lumbar spine: A clinical and experimental study in man. Spine 1985;10:236～241
[6] Frobin W, Brinckmann P, Biggemann M ,et al. Precision measurement of disc height ,vertebral height and sagittal plane displacement from lateral radiographic views of the lumbar spine. Clin Biomech 1997; 12(suppl ): S1～63
[7] Frobin W, Brinckmann P, Kramer M, et al. Height of lumbar discs measureed from radiographs compared with degeneration and height classified from MR images. Eur. Radiol. 2001; 11:263～269
[8] 刘正津 陈尔瑜．临床解剖学丛书(胸部和脊柱分册)人民卫生出版社1989；P321～325
[9] Hurxthal L, Measurement of anterior vertebral compressions and biconcave vertebrae. J Am Radial 1968; 103: 35～644
[10] Modic MT, Pavlicek W ,Weinstein M, et al. Magnetic resonance imaging of intervertebral disk disease .Radiology 1984;152;103～111
[11] Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease .Radiology 1988;168:177～186
[12] Yu S, Hanghton VM,Sother LA, et al. Criteria for classifying normal and degenerated lumbar intervertebral disks. Radiology 1989;170:523～526
[13] Erkintalo MO, Salminen JJ, Alanen AM, et al. Development of degenerative changes in the lumber intervertebral disk: results of a prospective MR imaging study in adolescents with and without low-back pain. Radiology 1995;196:529～533
[14] Gries NC. Berlemann U, Moore RJ, et al. Earlyhistologic changes in lower lumbar discs and facet joints and their correlation .Eur Spine J 2000; 9:23～29
[15] 村田雅明 人腰椎间盘的MRI和组织生化学比较[日]国外医学 临床放射学分册1995；1：52
[16] Tertti M, Paajanen H, Laato M, et al. Disc degeneretion in magnetic resonance imaging: a comparative biochemical, histologic and radiologic study in cadaver spines .Spine 1991;16(6) 629～634
[17] Miller J.A.A, Schmatz C. BS, Schultz A.B. Lumbar disc degeneration: correlation with age ,sex and spine level in 600 autopsy specimens .Spine 1988;13(2):173～178
[18] Ho PSP, Yu S, Sether LA, et al. Progressive and regressive changes in the nucleus pulposus. Part Ⅰ: the neonate. Radiology 1988;169:87～91
[19] 江浩 骨与关节MRI 上海科学技术出版社．上海1999：48～58
[20] Modic MT. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 1988; 166:193～199
[21] Deroos A. MR imaging of marrow changes adjacent to end plates in degenerative lumbar disc disease. AJR 1987; 149:531～534
[22] 李果珍 临床CT诊断学 中国科学技术出版社 北京 1994：654～663
[23] 金丕焕 医用统计方法 上海医科大学出版社 上海 1993：15～44
[24] 尚铁松 王云钊 腰椎间盘退变的X线、MRI表现与病理对照 中华
放射学杂志 2002：36(9)：828～832
[25] Berlemann U, Gries N.C, Moore R.J .The relationship between height, shape and histological changes in early degeneration of the lower lumbar discs, Eur Spine J 1998; 7:712～217