CAJ | 학술논문

目的探讨椎间盘退变程度对退变性腰椎侧凸(DLS)脊柱柔韧性的影响.方法回顾性分析2008年5月至2014年2月66例诊断为DLS患者的一般资料,其中男性10例,女性56例,平均年龄58.4岁(45 ～ 70岁),所有患者均有完整的影像学资料,包括术前立位全脊柱正位X线片、Bending位X线片、MRI等.分别测量术前立位全脊柱正位X线片主弯Cobb角和椎间角,Bending位X线片主弯Cobb角和椎间角,根据椎间盘Pfirrmann分级评估记录主弯区问各个椎间盘退变等级,计算脊柱整体柔韧性与各节段柔韧性,分析椎间盘退变等级与脊柱整体柔韧性以及节段柔韧性的相关性.结果 66例DLS患者术前立位片平均主弯Cobb角为36°±13°,Bending位片平均Cobb角为(21°±11)°,平均柔韧性为45％±15％;共评估记录268个椎间盘的退变等级,其中Ⅰ级8个,Ⅱ级68个,Ⅲ级83个,Ⅳ级91个,Ⅴ级18个.主弯跨度内椎间盘平均退变等级与脊柱整体的柔韧性具有显著相关性(r=-0.727,P ＜0.01).各节段椎间盘退变等级与相应节段柔韧性具有显著相关性(P＜0.01).顶椎区椎间盘相对于其他椎间盘退变程度严重(P＜0.01),其节段柔韧性也最差(P＜0.01).结论椎间盘退变程度与DLS脊柱柔韧性密切相关,椎间盘退变越严重,脊柱的柔韧性越差.
목적 탐토추간반퇴변정도대퇴변성요추측철(DLS)척주유인성적영향.방법 회고성분석2008년5월지2014년2월66례진단위DLS환자적일반자료,기중남성10례,녀성56례,평균년령58.4세(45 ～ 70세),소유환자균유완정적영상학자료,포괄술전립위전척주정위X선편、Bending위X선편、MRI등.분별측량술전립위전척주정위X선편주만Cobb각화추간각,Bending위X선편주만Cobb각화추간각,근거추간반Pfirrmann분급평고기록주만구문각개추간반퇴변등급,계산척주정체유인성여각절단유인성,분석추간반퇴변등급여척주정체유인성이급절단유인성적상관성.결과 66례DLS환자술전립위편평균주만Cobb각위36°±13°,Bending위편평균Cobb각위(21°±11)°,평균유인성위45％±15％;공평고기록268개추간반적퇴변등급,기중Ⅰ급8개,Ⅱ급68개,Ⅲ급83개,Ⅳ급91개,Ⅴ급18개.주만과도내추간반평균퇴변등급여척주정체적유인성구유현저상관성(r=-0.727,P ＜0.01).각절단추간반퇴변등급여상응절단유인성구유현저상관성(P＜0.01).정추구추간반상대우기타추간반퇴변정도엄중(P＜0.01),기절단유인성야최차(P＜0.01).결론 추간반퇴변정도여DLS척주유인성밀절상관,추간반퇴변월엄중,척주적유인성월차.
Objective To investigate degenerative changes of the intervertebral disc and their impact on spinal flexibility in patients with degenerative lumbar scoliosis(DLS).Methods Retrospective analysis of 66 patients (average age 58.4 years,10 males ant 56 females) with DLS was conducted from May 2008 to February 2014.For all patients,pre-operative standing X-ray film,Bending X-ray films and thoracolumbar MRI were taken.Cobb's angle was measured in each X-ray film and intervertebral angle was measured in both standing and Bending X-ray films.All discs were graded according to Pfirrmann degeneration grades on T2 weighted saggital MRI imaging.Statistical analyses were performed to determine the correlation between intervertebral disc degeneration with the whole spine flexibility and segmental flexibility.Results For all 66 subjects,the average Cobb's angle of pre-operative and bending X-ray film was 36° ± 13°,21° ± 11°,respectively.The average flexibility was 45％ ± 15％ in our study.Totally 268 discs were graded,including grade Ⅰ 8,Ⅱ 68,Ⅲ 83,Ⅳ 91,Ⅴ 18.In the main curve,there was significant correlation between the average degree of disc degeneration and the whole spine flexibility (r =-0.727,P ＜ 0.01).There was significant correlation between the grade of segmental disc degeneration and segmental flexibility(P ＜ 0.01).The apical intervertebral disc had the most degeneration (P ＜ 0.01) and worst flexibility(P ＜ 0.01),compared with other discs in the main curve.Conclusions The degree of intervertebral disc degeneration is closely correlated with spinal flexibility in DLS.The more the disc degeneration is,the worse the spinal flexibility becomes.