中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2011年
5期
436-441
,共6页
石泽锋%陈仲强%刘宁%齐强
石澤鋒%陳仲彊%劉寧%齊彊
석택봉%진중강%류저%제강
胸椎%腰椎%椎间盘移位%Scheuermann病
胸椎%腰椎%椎間盤移位%Scheuermann病
흉추%요추%추간반이위%Scheuermann병
Thoracic vertebrae%Lumbar vertebrae%Intervertebral disk displacement%Scheuermann's disease
目的 探讨胸腰段椎间盘突出症(thoracolumbardisc herniation,TLDH)和休门病的内在联系以及休门病在TLDH发病中的作用.方法 2006年6月至2010年6月,以45例因TLDH(T10-11～L2-3)手术的患者作为研究组(TLDH组),及同期手术的低位(L3-4～L5S1)腰椎间盘突出症(1umbardisc herniation,LDH)患者中随机抽取45例作为对照组(LDH组).通过复习其CT、MRI和X线片,对比两组合并休门病和各种影像学休门样改变的比例,并比较两组的胸腰段后凸角度.进一步在TLDH组内部分别对比存在各种休门样改变的节段和无休门样改变节段合并椎间盘突出的比例.结果 TLDH组97.8%(44/45)的患者均合并休门病,LDH组仅为26.7%(12/45;x2=48.403,P=0.000).TLDH组出现各种休门样改变的比例均高于LDH组,分别为许莫结节66.7%(30/45)和15.6%(7/45;x2=24.278,P=0.000),终板不规则88.9%(40/45)和15.6%(7/45;x2=48.496,P=0.000),椎体后缘离断75.6%(34/45)和13.3%(6/45;x2=35.280,P=0.000),相邻椎体楔形变93.3%(42/45)和0%(x2=78.750,P=0.000).TLDH组患者平均胸腰段后凸角15.8°±6.9°,LDH组为4.8°±4.0°(t=7.703,P＜0.001).TLDH组内,存在许莫结节(32.8%,39/119;x2=9.276,P=0.002),终板不规则(50.0%,55/110;x2=22.255,P=0.000),椎体后缘离断(100%,40/40;x2=69.421,P=0.000)和椎体楔形变(39.5%,58/147;x2=14.631,P=0.000)的节段发生椎间盘突出的比例均高于无休门样改变的节段(9.1%,4/44).结论 胸腰段椎间盘突出症与休门病关系密切,前者可能是后者的一种表现.许莫结节、终板不规则、椎体楔形变,尤其是椎体后缘离断,与椎间盘突出的发生有关.
目的 探討胸腰段椎間盤突齣癥(thoracolumbardisc herniation,TLDH)和休門病的內在聯繫以及休門病在TLDH髮病中的作用.方法 2006年6月至2010年6月,以45例因TLDH(T10-11～L2-3)手術的患者作為研究組(TLDH組),及同期手術的低位(L3-4～L5S1)腰椎間盤突齣癥(1umbardisc herniation,LDH)患者中隨機抽取45例作為對照組(LDH組).通過複習其CT、MRI和X線片,對比兩組閤併休門病和各種影像學休門樣改變的比例,併比較兩組的胸腰段後凸角度.進一步在TLDH組內部分彆對比存在各種休門樣改變的節段和無休門樣改變節段閤併椎間盤突齣的比例.結果 TLDH組97.8%(44/45)的患者均閤併休門病,LDH組僅為26.7%(12/45;x2=48.403,P=0.000).TLDH組齣現各種休門樣改變的比例均高于LDH組,分彆為許莫結節66.7%(30/45)和15.6%(7/45;x2=24.278,P=0.000),終闆不規則88.9%(40/45)和15.6%(7/45;x2=48.496,P=0.000),椎體後緣離斷75.6%(34/45)和13.3%(6/45;x2=35.280,P=0.000),相鄰椎體楔形變93.3%(42/45)和0%(x2=78.750,P=0.000).TLDH組患者平均胸腰段後凸角15.8°±6.9°,LDH組為4.8°±4.0°(t=7.703,P＜0.001).TLDH組內,存在許莫結節(32.8%,39/119;x2=9.276,P=0.002),終闆不規則(50.0%,55/110;x2=22.255,P=0.000),椎體後緣離斷(100%,40/40;x2=69.421,P=0.000)和椎體楔形變(39.5%,58/147;x2=14.631,P=0.000)的節段髮生椎間盤突齣的比例均高于無休門樣改變的節段(9.1%,4/44).結論 胸腰段椎間盤突齣癥與休門病關繫密切,前者可能是後者的一種錶現.許莫結節、終闆不規則、椎體楔形變,尤其是椎體後緣離斷,與椎間盤突齣的髮生有關.
목적 탐토흉요단추간반돌출증(thoracolumbardisc herniation,TLDH)화휴문병적내재련계이급휴문병재TLDH발병중적작용.방법 2006년6월지2010년6월,이45례인TLDH(T10-11～L2-3)수술적환자작위연구조(TLDH조),급동기수술적저위(L3-4～L5S1)요추간반돌출증(1umbardisc herniation,LDH)환자중수궤추취45례작위대조조(LDH조).통과복습기CT、MRI화X선편,대비량조합병휴문병화각충영상학휴문양개변적비례,병비교량조적흉요단후철각도.진일보재TLDH조내부분별대비존재각충휴문양개변적절단화무휴문양개변절단합병추간반돌출적비례.결과 TLDH조97.8%(44/45)적환자균합병휴문병,LDH조부위26.7%(12/45;x2=48.403,P=0.000).TLDH조출현각충휴문양개변적비례균고우LDH조,분별위허막결절66.7%(30/45)화15.6%(7/45;x2=24.278,P=0.000),종판불규칙88.9%(40/45)화15.6%(7/45;x2=48.496,P=0.000),추체후연리단75.6%(34/45)화13.3%(6/45;x2=35.280,P=0.000),상린추체설형변93.3%(42/45)화0%(x2=78.750,P=0.000).TLDH조환자평균흉요단후철각15.8°±6.9°,LDH조위4.8°±4.0°(t=7.703,P＜0.001).TLDH조내,존재허막결절(32.8%,39/119;x2=9.276,P=0.002),종판불규칙(50.0%,55/110;x2=22.255,P=0.000),추체후연리단(100%,40/40;x2=69.421,P=0.000)화추체설형변(39.5%,58/147;x2=14.631,P=0.000)적절단발생추간반돌출적비례균고우무휴문양개변적절단(9.1%,4/44).결론 흉요단추간반돌출증여휴문병관계밀절,전자가능시후자적일충표현.허막결절、종판불규칙、추체설형변,우기시추체후연리단,여추간반돌출적발생유관.
Objective To explore the relationship between thoracolumbar disc herniation (TLDH) and Scheuermann1's disease (SD),as well as the role of SD in the etiology of TLDH.Methods From June 2006 to June 2010,45 patients with TLDH (T10-11-L2-3) underwent surgery in our department.Forty-five patients with lower lumbar disc herniation (LDH,L3-4-L5S1) acted as controls.The incidence of SD and Scheuermann's signs of these patients were examined by reviewing CT,MRI and Ⅹ-ray films.The thoracolumbar kyphotic angles of the two groups were compared.Furthermore,in TLDH group,the incidence of disk herniation within segments with the Scheuermann's signs was compared to that within segments without Scheuermann's signs.Results All except one patient in TLDH group(97.8%) had been associated SD while the incidence of SD in LDH group was only 26.7%.The incidence of all Scheuennann's signs was higher in TLDH group than that in LDH group.The average thoracolumbar kyphotic angle of TLDH group was 15.8°±6.9° while that of LDH group was 4.8°±4.0°.In TLDH group,the incidence of disc herniation within segments with Scheuermann's signs was all higher than that within segments without Scheuermann's signs.Conclusion There is a close relationship between TLDH and SD,suggesting that TLDH is probably a manifestation of SD.Schmorl's node,irregular end plate,wedge-shaped vertebra and especially,posterior bony edge separation,are associated with disc herniation.
