腰椎间盘退变时椎体的形态变化及其临床意义

目的:研究腰椎间盘退变时椎体形态的变化规律,并探讨其临床意义。方法:111例研究对象分成3组:对照组27例,L4/5椎间盘轻度退变组53例,重度退变组31例。将所有研究对象的X线片及MRI片输入计算机,在侧位X线片上测量椎体的前高、后高及矢状径,并计算椎体矩形指数及相对高度和矢状径,在MRI上观察退变椎间盘相邻椎体骨髓信号改变。结果:(1)对照组L4、L5椎体矩形指数男女间无显著性差异(P>0.05);(2)L4、L5椎体矩形指数在对照组、腰椎间盘轻度和重度退变组逐渐减小,两两间有显著性差异(P<0.05);(3)L4、L5椎体相对前高和后高在对照组、腰椎间盘轻度和重度退变组逐渐减小而相对矢状径逐渐增加,两两间有显著性差异(P<0.05);(4)椎体骨髓的MRI信号改变区域主要位于外周终板的下方,重度退变组的信号改变率大于轻度退变组,差异有显著性(P<0.05)。结论:腰椎间盘退变时椎体倾向扁平化,其扁平化程度与椎间盘退变的严重程度有关。

The change of vertebral body shape in lumbar disc degeneration and its clinical significance

Objective:To examine the influence of lumbar disc degeneration on vertebral body shape.Method:Of the111subjects,27asymptomatic volunteers were control group;84patients with L45disc degeneration were divided into two groups:light degeneration group with53cases and severe degeneration group with31cases.Radiographs of lumbar spine were inputted personal computer,the heights and sagital diameters of vertebral body were measured by image analysis software,the rectangular indices and the relative heights and sagital diameters of L4and L5were calculated.Result:(1)There was no significant difference between male and female in the rectangular index of vertebral body(P>0.05);(2)The rectangular indices of vertebral body significantly decreased among the control group,light degeneration group and severe degeneration group(P<0.05);(3)The relative anterior and posterior heights of vertebral body significantly decreased among control group,light degeneration group and severe degeneration group,but the relative sagital diameters significantly increased(P<0.05);(4)The region of the signal changes in vertebral body marrow was mainly located in inferior aspect of peripheral endplate and the ratio of the signal changes showed significantly difference between light degeneration group(21%)and severe degeneration group(45%)(P<0.05).Conclusion:In patients with lumbar disc degeneration,the vertebral body is becoming oblate which corresponds with the severity of degeneration;to investigate the change of vertebral body shape is very valuable for the diagnosis and therapy of lumbar disc degeneration.