退行性脊柱侧凸临床表现、中医证型与影像学改变的相关性研究
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摘要
目的:退行性脊柱侧凸为中老年人腰痛、下肢痛、神经源性间歇性跛行的重要原因之一。本病在影像学上有较多生理、病理改变,临床治疗上通常以针对症状治疗为主,不一定要求完全矫正侧凸畸形,因此,本病的治疗关键在于明确责任节段采取相应治疗方案。另一方面,辨证论治是中医理论的基本特征,因此,在退行性脊柱侧凸的研究中,对其中医证型的病理基础进行研究具有重要意义。本文通过回顾性研究,借助统计学方法,对退行性脊柱侧凸的中医证型、临床表现及影像学改变进行综合研究,发掘其内在联系,借以探讨和比较本病的治疗方法,并探寻其证型与影像学改变之间是否存在相关性。
方法:采用回顾性研究,从2008.3-2009.3在广州军区总医院脊柱外科及中山市中医院脊柱外科住院的51名退行性脊柱侧凸的患者进行临床检查并收集其四诊资料,拍摄腰椎X线正侧位片及MRI检查,所得临床及影像资料输入SPSS13.0数据库,将退行性脊柱侧凸的中医分型、临床表现及影像学改变各自进行统计分析,获得统计结果并进行比较。
结果:51例患者均有不同程度腰痛,且凸侧出现腰痛的概率更高。下肢症状表现为下肢神经根分布区域的疼痛、麻木及乏力等,部分病例有间歇性跛行。顶椎分布以L3多见,MRI检查可见腰椎间盘突出或椎管狭窄节段大多位于L3/4、L4/5、L5/S1节段。神经损害一般出现于顶椎水平或以下。通过对不同证型腰椎侧凸患者之间影像学改变(顶椎分布及侧凸、增生程度)进行统计分析后,显示各证型腰椎侧凸患者X线改变差异无统计学意义。51例患者当中有49例患者具有不同程度肾虚症状,占本组患者例数的96.078%。
结论:
1、退行性脊柱侧凸患者凸侧出现腰痛的概率更高。
2、退行性脊柱侧凸的神经损害则一般出现于顶椎水平或以下,这对临床手术椎管减压节段可提供参考。
3、退行性脊柱侧凸以腰弯最常见,其次为胸腰段弯,未发现有胸弯患者,弯度小,顶椎多在L3、L4,节段短,腰前凸减小,MRI检查可见广泛腰椎间盘及小关节退变,以此有助于区别由特发性脊柱侧凸进展而来的侧凸。
4、不同证型腰椎侧凸患者之间影像学改变(顶椎分布及侧凸、增生程度)差异无统计学意义。
5、退行性脊柱侧凸患者多有肾虚症状,在治疗时亦予以补益肾之精气,以达到标本兼顾、扶正祛邪之功效。
Objective:Degenerative scoliosis is the One of the important reasons about Middle-aged and elderly for low back pain,lower limb pain, neurogenic intermittent claudication.there are more physiological and pathological changes in Imageology,the main treatment for the symptoms of degenerative scoliosis in clinical,does not necessarily require the full correction of scoliosis,The keyis take appropriate treatment options for the appropriate segments of scoliosis.On the other hand,the theory of treatment with syndrome differentiation is the basic feature of TCM.Study of the TCM Syndrome has great significance in degenerative scoliosis.In this paper,by way of retrospective study and Statistical Methods,the comprehensive study of clinical manifestations,TCM syndrome and imaging changes in degenerative scoliosis,to explore the internal relations in order to explore and compare the cure methods of the disease, and explore between the TCM Syndrome and imaging changes the existence of correlation.
[Methods]The use of retrospective study,from 2008.3-2009.3 in the General Hospital of Guangzhou Military Region Spine Surgery,Zhongshan City,spine surgery of TCM,51 patients of the clinical examination and collection of the four diagnostic information,Shooting are lateral lumbar spine X-ray film,MRI examination,importing clinical datas and imaging datas in SPSS13.0 database.Statistics Analysis of degenerative scoliosis type of TCM Syndrome,clinical manifestation and image changes, obtainning and comparing the statistical results.
[Results]The 51 of cases have low back pain in varying degrees,and the convex side of spine has higher probability of emergence of low back pain. Symptoms of lower extremity:nerve root distribution of lower extremity pain,numbness and weakness and so on,some patients have intermittent claudication.protruding vertebra distribution of L3,MRI examination showed lumbar disc herniation or spinal stenosis,mostly in segment L3/4,L4/5,L5/S1 segment.Nerve damage commonly arise in the protruding vertebra level or below.Syndromes of different and imaging changes(protruding vertebra distribution and scoliosis,the degree of hyperplasia) after statistical analysis shows that Syndromes of different about spine X-ray changes in patients with scoliosis was no significant difference.The 51 cases of patients with 49 cases of patients with renal weakness symptoms in varying degrees,accounting for 96.078%of all the patients.
[Conclusion]1、The convex side of spine has higher probability of emergence of low back pain.2、Nerve damage commonly arise in the protruding vertebra level or below,this clinical can provide a reference segment surgical decompression.3、Degenerative lumbar scoliosis to be the most common,followed by thoracolumbar,not found in patients with dorsal vertebra,curves of small,most protruding vertebra in L3,L4,short segments,reduced lumbar lordosis,MRI examination showed extensive lumbar intervertebral disc degeneration and Facet joints in order to contribute to the difference from idiopathic scoliosis scoliosis progress from
4、The syndromes of different about spine X-ray changes in patients with scoliosis was no significant difference
5、Most of patients have symptoms of renal weakness in degenerative scoliosis,in the treatment of benefit the vital essence and energy in order to treat a disease by looking into both its root cause and symptoms, the effect of support healthy trends and get rid of bad energy
方法:采用回顾性研究,从2008.3-2009.3在广州军区总医院脊柱外科及中山市中医院脊柱外科住院的51名退行性脊柱侧凸的患者进行临床检查并收集其四诊资料,拍摄腰椎X线正侧位片及MRI检查,所得临床及影像资料输入SPSS13.0数据库,将退行性脊柱侧凸的中医分型、临床表现及影像学改变各自进行统计分析,获得统计结果并进行比较。
结果:51例患者均有不同程度腰痛,且凸侧出现腰痛的概率更高。下肢症状表现为下肢神经根分布区域的疼痛、麻木及乏力等,部分病例有间歇性跛行。顶椎分布以L3多见,MRI检查可见腰椎间盘突出或椎管狭窄节段大多位于L3/4、L4/5、L5/S1节段。神经损害一般出现于顶椎水平或以下。通过对不同证型腰椎侧凸患者之间影像学改变(顶椎分布及侧凸、增生程度)进行统计分析后,显示各证型腰椎侧凸患者X线改变差异无统计学意义。51例患者当中有49例患者具有不同程度肾虚症状,占本组患者例数的96.078%。
结论:
1、退行性脊柱侧凸患者凸侧出现腰痛的概率更高。
2、退行性脊柱侧凸的神经损害则一般出现于顶椎水平或以下,这对临床手术椎管减压节段可提供参考。
3、退行性脊柱侧凸以腰弯最常见,其次为胸腰段弯,未发现有胸弯患者,弯度小,顶椎多在L3、L4,节段短,腰前凸减小,MRI检查可见广泛腰椎间盘及小关节退变,以此有助于区别由特发性脊柱侧凸进展而来的侧凸。
4、不同证型腰椎侧凸患者之间影像学改变(顶椎分布及侧凸、增生程度)差异无统计学意义。
5、退行性脊柱侧凸患者多有肾虚症状,在治疗时亦予以补益肾之精气,以达到标本兼顾、扶正祛邪之功效。
Objective:Degenerative scoliosis is the One of the important reasons about Middle-aged and elderly for low back pain,lower limb pain, neurogenic intermittent claudication.there are more physiological and pathological changes in Imageology,the main treatment for the symptoms of degenerative scoliosis in clinical,does not necessarily require the full correction of scoliosis,The keyis take appropriate treatment options for the appropriate segments of scoliosis.On the other hand,the theory of treatment with syndrome differentiation is the basic feature of TCM.Study of the TCM Syndrome has great significance in degenerative scoliosis.In this paper,by way of retrospective study and Statistical Methods,the comprehensive study of clinical manifestations,TCM syndrome and imaging changes in degenerative scoliosis,to explore the internal relations in order to explore and compare the cure methods of the disease, and explore between the TCM Syndrome and imaging changes the existence of correlation.
[Methods]The use of retrospective study,from 2008.3-2009.3 in the General Hospital of Guangzhou Military Region Spine Surgery,Zhongshan City,spine surgery of TCM,51 patients of the clinical examination and collection of the four diagnostic information,Shooting are lateral lumbar spine X-ray film,MRI examination,importing clinical datas and imaging datas in SPSS13.0 database.Statistics Analysis of degenerative scoliosis type of TCM Syndrome,clinical manifestation and image changes, obtainning and comparing the statistical results.
[Results]The 51 of cases have low back pain in varying degrees,and the convex side of spine has higher probability of emergence of low back pain. Symptoms of lower extremity:nerve root distribution of lower extremity pain,numbness and weakness and so on,some patients have intermittent claudication.protruding vertebra distribution of L3,MRI examination showed lumbar disc herniation or spinal stenosis,mostly in segment L3/4,L4/5,L5/S1 segment.Nerve damage commonly arise in the protruding vertebra level or below.Syndromes of different and imaging changes(protruding vertebra distribution and scoliosis,the degree of hyperplasia) after statistical analysis shows that Syndromes of different about spine X-ray changes in patients with scoliosis was no significant difference.The 51 cases of patients with 49 cases of patients with renal weakness symptoms in varying degrees,accounting for 96.078%of all the patients.
[Conclusion]1、The convex side of spine has higher probability of emergence of low back pain.2、Nerve damage commonly arise in the protruding vertebra level or below,this clinical can provide a reference segment surgical decompression.3、Degenerative lumbar scoliosis to be the most common,followed by thoracolumbar,not found in patients with dorsal vertebra,curves of small,most protruding vertebra in L3,L4,short segments,reduced lumbar lordosis,MRI examination showed extensive lumbar intervertebral disc degeneration and Facet joints in order to contribute to the difference from idiopathic scoliosis scoliosis progress from
4、The syndromes of different about spine X-ray changes in patients with scoliosis was no significant difference
5、Most of patients have symptoms of renal weakness in degenerative scoliosis,in the treatment of benefit the vital essence and energy in order to treat a disease by looking into both its root cause and symptoms, the effect of support healthy trends and get rid of bad energy
引文
1 Daffner SD,Vaccaro AR.Adult degene rative lumbarscoliosis.Am J Orthop,2003,32(2):77-82.
2 Tribus CB.Degenerativ lumbar scoliosis:evaluation and management.J Am Acad Orthop Surg,2003,11(3):174-183.
3 胥少汀、葛宝丰、徐印坎等主编,《实用骨科学》第三版,北京:人民军医出版社,2005,3:1732.
4 Guillaumat M.Natural history of scoliosis from childhood to old age.Bull Acad Natl Med,1999,183(4):705-718.
5 史亚民,张光铂.如何掌握退变性脊柱侧凸的手术适应证[J].中国脊柱脊髓杂志,2006,16(3):178-179
6 Oskouian RJ Jr,Shaffrey CI.Degenerative lumbar scoliosis[J].Neurosurg Clin N Am,2006,17(3):299-315.
7 Kobayashi T,Atsuta Y,Takemitsu M,et al.A prospective studyof de novo scoliosis in a community based cohort[J].Spine,2006,31(2):178-182.
8 Faldini C,Pagkrati S,Grandi G,et al.Degenerative lumbar sco-liosis:features and surgical treatment[J].J Orthop Traumatol,2006,7(2):67-71.
9 贾连顺,老年人退变性腰椎侧凸症几个问题[J].老年医学与保健,2007,13(6):329-332.
10 Aebi M.The adult scoliosis[J].Eur Spine J,2005,14(10):925-948.
11 Shufflebarger H,Suk SI,Mardjetko S.Debate:determining theupper instrumented vertebra in the management of adult degenerative scoliosis:stopping at T10 versus L1[J].Spine,2006,31(Suppl 19):185-194.
12 Weidenbaum M.Considerations for focused surgical interventionin the presence of adult spinal deformity[J].Spine,2006,31(Suppl 19):139-143.
13 Kuklo TR.Principles for selecting fusion levels in adult spinaldeformity with particular attention to lumbar curves anddouble major curves[J].Spine,2006,31(Suppl 19):132-138.
14 王岩,张雪松,张永刚,等.退行性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2):170-173.
15 Lowe T,Berven SH,Schwab FJ,et al.The SRS classification for adult spinal deformity:building on the King/Moe and Lenke classification systems[J].Spine,2006,31(Suppl 19):119-125.
16 Schwab F,Farcy JP,Bridwell K,et al.A clinical impact classification of scoliosis in the adult[J].Spine,2006,31(18):2109-2114.
17 Schwab F,LafageV,Farcy JP,et al.Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification[JJ.Spine,2007,32(24):2723-2730.
18 Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J].Clin Orthop,2001,384(1):45-53.
19 Ploumis A,Transfledt EE,Denis F.Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J,2007,7(4):428-436.
20 M·南丁,V·H·傅兰谷著,过邦辅编.临床骨科生物力学基础[M].上海,上海远东出版社,1993:252-284.
21 Gordon SJ,Yang KH,Mayer PJ,et al.Mechanism of disc rupture:a preliminary report[J].Spine,1991,16:450-456.
22 Farfan HF,Huberdeau RM,Dubow HI,et a1.Lumbar intervertebral disc degeneration:the influence of geometrical features on the pattern of disc degeneration-----a post mortem study.J Bone Joint Surg[Am],1972,54:492-510.
23 胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,1993,109-110.
24 Dunlop RB.Disc space narrowing and the lumbar facet joints[J].J bone Joint Surg(Br),1984,66B:706.
25 Cyron BM,Hutton WC.Atricular tropism and stability of the lumbar spine[J].Spine,1980,5:168.
26 Barrios C,Lapuent JP,Sastre S.Treat ment of chronic pain in adult scolisis.Stud Health Technol In Form,2002,88:290-303.
27 MurataY,Takahashi K,HanaokaE,et al.Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar soliosis.Spine,2002,27(20):2268-2273.
28 Canale ST.Campbell's operative orthopaedics.Mosby Year Book,2003,3(6):524-529.
29 Liu H,Ishihara H,Kanamori M,et al.Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.Spine,2003,3(6):524-529.
30 Ogilvie JW.Adult scoliosis:evaluation and nonsurgical treatment.Instr Course Lect,1992,41:251～255.
31 Bridwell KH.Degenerative scoliosis.In Bridwell KH.The textbook of spinal surgery.Philadelphia:JB Lippincott,1997,728～741.
32 Wilson-MacDonald J,BurrG,Griffin D,Glynn C.Epidural steroid injection for nerve root compression.A randomized,Controlled trial[J].J Bone Joint Surg Br,2005,87:352-5.
33 Simmons ED.Surgical treatment of patients with lumbar spinal stenosis.Clin Orthop,2001,(384):45～53.
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50 Perennou D,Marcelli C,Hersson C,et al.Adult lumbar scoliosis,Epidemiologic spects in a low-back pain populatio[J].Spine,1994,19(2):123-128.
51 Robin GC,Span Y,Steinberg R,et al.Scoliosis in the elderly.a follow-up study[J].Spine,1982,7(2):355-359.
52 LonsteinJE.Adolescent idiopathic scoliosis[J].Lancet,1994,344(8934):1407-1412.
53 Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis[J].Spine,2002,27(4):387-392.
2 Tribus CB.Degenerativ lumbar scoliosis:evaluation and management.J Am Acad Orthop Surg,2003,11(3):174-183.
3 胥少汀、葛宝丰、徐印坎等主编,《实用骨科学》第三版,北京:人民军医出版社,2005,3:1732.
4 Guillaumat M.Natural history of scoliosis from childhood to old age.Bull Acad Natl Med,1999,183(4):705-718.
5 史亚民,张光铂.如何掌握退变性脊柱侧凸的手术适应证[J].中国脊柱脊髓杂志,2006,16(3):178-179
6 Oskouian RJ Jr,Shaffrey CI.Degenerative lumbar scoliosis[J].Neurosurg Clin N Am,2006,17(3):299-315.
7 Kobayashi T,Atsuta Y,Takemitsu M,et al.A prospective studyof de novo scoliosis in a community based cohort[J].Spine,2006,31(2):178-182.
8 Faldini C,Pagkrati S,Grandi G,et al.Degenerative lumbar sco-liosis:features and surgical treatment[J].J Orthop Traumatol,2006,7(2):67-71.
9 贾连顺,老年人退变性腰椎侧凸症几个问题[J].老年医学与保健,2007,13(6):329-332.
10 Aebi M.The adult scoliosis[J].Eur Spine J,2005,14(10):925-948.
11 Shufflebarger H,Suk SI,Mardjetko S.Debate:determining theupper instrumented vertebra in the management of adult degenerative scoliosis:stopping at T10 versus L1[J].Spine,2006,31(Suppl 19):185-194.
12 Weidenbaum M.Considerations for focused surgical interventionin the presence of adult spinal deformity[J].Spine,2006,31(Suppl 19):139-143.
13 Kuklo TR.Principles for selecting fusion levels in adult spinaldeformity with particular attention to lumbar curves anddouble major curves[J].Spine,2006,31(Suppl 19):132-138.
14 王岩,张雪松,张永刚,等.退行性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2):170-173.
15 Lowe T,Berven SH,Schwab FJ,et al.The SRS classification for adult spinal deformity:building on the King/Moe and Lenke classification systems[J].Spine,2006,31(Suppl 19):119-125.
16 Schwab F,Farcy JP,Bridwell K,et al.A clinical impact classification of scoliosis in the adult[J].Spine,2006,31(18):2109-2114.
17 Schwab F,LafageV,Farcy JP,et al.Surgical rates and operative outcome analysis in thoracolumbar and lumbar major adult scoliosis:application of the new adult deformity classification[JJ.Spine,2007,32(24):2723-2730.
18 Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J].Clin Orthop,2001,384(1):45-53.
19 Ploumis A,Transfledt EE,Denis F.Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J,2007,7(4):428-436.
20 M·南丁,V·H·傅兰谷著,过邦辅编.临床骨科生物力学基础[M].上海,上海远东出版社,1993:252-284.
21 Gordon SJ,Yang KH,Mayer PJ,et al.Mechanism of disc rupture:a preliminary report[J].Spine,1991,16:450-456.
22 Farfan HF,Huberdeau RM,Dubow HI,et a1.Lumbar intervertebral disc degeneration:the influence of geometrical features on the pattern of disc degeneration-----a post mortem study.J Bone Joint Surg[Am],1972,54:492-510.
23 胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,1993,109-110.
24 Dunlop RB.Disc space narrowing and the lumbar facet joints[J].J bone Joint Surg(Br),1984,66B:706.
25 Cyron BM,Hutton WC.Atricular tropism and stability of the lumbar spine[J].Spine,1980,5:168.
26 Barrios C,Lapuent JP,Sastre S.Treat ment of chronic pain in adult scolisis.Stud Health Technol In Form,2002,88:290-303.
27 MurataY,Takahashi K,HanaokaE,et al.Changes in scoliotic curvature and lordotic angle during the early phase of degenerative lumbar soliosis.Spine,2002,27(20):2268-2273.
28 Canale ST.Campbell's operative orthopaedics.Mosby Year Book,2003,3(6):524-529.
29 Liu H,Ishihara H,Kanamori M,et al.Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis.Spine,2003,3(6):524-529.
30 Ogilvie JW.Adult scoliosis:evaluation and nonsurgical treatment.Instr Course Lect,1992,41:251～255.
31 Bridwell KH.Degenerative scoliosis.In Bridwell KH.The textbook of spinal surgery.Philadelphia:JB Lippincott,1997,728～741.
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33 Simmons ED.Surgical treatment of patients with lumbar spinal stenosis.Clin Orthop,2001,(384):45～53.
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