摘要
目的探讨单节段腰椎间盘突出症患者腰椎椎体之间和椎体内不同区域骨密度的分布特点及其临床意义。方法回顾性研究。纳入2013年1月—2020年12月在河北医科大学第三医院脊柱外科单节段腰椎间盘突出症患者100例,其中男、女各50例,年龄21~69岁。100例患者按年龄分为21~30岁、31~40岁、41~50岁、51~60岁、61~70岁5个年龄组,均接受腰椎后路减压椎间融合术治疗。在L_(1)~S_(1)椎体CT正中矢状位影像选择松质骨范围最大的区域测量其HU值,进而将L_(1~5)椎体自上而下三等分,分别测量每一等份内松质骨的HU值;基于腰椎MRI,采用Pfirrmann分级标准评估椎间盘退变程度。对比5组患者基线资料;比较不同年龄组间及同一年龄组内L_(1~5)不同椎体间的松质骨HU值,分析同一腰椎节段上、中、下不同区域椎体松质骨HU值;观察不同Pfirrmann分级的腰椎间盘上位与下位椎体松质骨HU值的变化趋势。结果各年龄组间患者的性别分布、体质量指数、病变节段、术前腰椎侧凸角等基线资料比较,差异均无统计学意义(P值均>0.05)。骨密度HU值在L_(1~5)各椎体之间并未表现出梯度差异,随着年龄增长L_(1~5)椎体HU值表现出下降趋势。L_(1~5)椎体内部存在骨密度梯度变化,上、中、下1/3椎体松质骨HU值依序增大,但差异均无统计学意义(P值均>0.05)。100例500个椎间盘中,Pfirrmann分级Ⅰ级4例、Ⅱ级204例、Ⅲ级186例、Ⅳ级93例、Ⅴ级13例;上位椎体和下位椎体松质骨HU值随着椎间盘退变分级的升高而减小,而上、下位椎体松质HU值差值则逐渐增大,差异均有统计学意义(F=21.46、5.25、20.39,P值均<0.01)。结论单节段腰椎间盘突出症患者腰椎不同椎体之间骨密度无梯度差异,而各腰椎椎体内部骨密度HU值表现出从头端向尾端增加的趋势。骨密度下降以及上下相邻椎体松质骨骨密度梯度的较大差值对于椎间盘退变可能具有病因学意义。
Objective To assess bone-mineral density distribution within lumbar vertebrae in patients with single-segment lumbar dise herniation based on Hounsfield unit(HU)measurement of lumbar CT.Methods One hundred single-segment lumbar-disc herniation patients who were surgically treated in the Third Hospital of Hebei Medical University from Jan 2013 to Oct 2020 were retrospectively reviewed.Of the 100 patients,50 were males,and 50 were females,and their age range was 21-69 years.They were divided into five groups according to age:group 1(21-30 years old),group 2(31-40 years old),group 3(41-50 years old),group 4(51-60 years old),and group 5(61-70 years old).HU measurement of the whole vertebrae from L_(1) to S_(1) was obtained.Then,HU measurements within the different regions of the vertebrae were obtained from L_(1) to L_(5).Disc degeneration on MRI was rated from gradeⅠtoⅤby using the Pfirrmann classification.Results No significant differences in the gender distribution,body mass index,segment,preoperative lumbar scoliosis,and other baseline data of patients were observed among all age groups(all P values>0.05).The HU value did not show gradient difference among the L_(1-5) vertebrae,and the HU value of the L_(1-5) vertebrae decreased with age.The HU values of cancellous bone in the upper,middle,and lower one-third vertebral bodies increased gradually,but the differences were not significant(F=21.46,5.25,20.39;all P values>0.01).Among 100 cases of 500 intervertebral discs,the Pfirrmann classification was gradeⅠin 4 discs,gradeⅡin 204 discs,gradeⅢin 186 discs,gradeⅣin 93 discs,and gradeⅤin 13 cases.Conclusion HU values were typically consistent throughout all levels of the lumbar vertebrae and presented a gradually decreasing trend within the vertebrae from the upper to lower region.Vertebral bone-mass decline and intervertebral bone gradient may trigger or aggravate the adjacent disc degeneration.
作者
王辉
李朝辉
刘庆涛
许星柱
丁文元
Wang Hui;Li Zhaohui;Liu Qingtao;Xu Xingzhu;Ding Wenyuan(Department of Spine,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)
出处
《中华解剖与临床杂志》
2022年第6期379-384,共6页
Chinese Journal of Anatomy and Clinics
基金
河北省高层次人才资助项目(A201803054)。
关键词
骨密度
椎间盘移位
腰椎
HU值
影像学检查
Bone density
Intervertebral disc displacement
Lumbar vertebrae
Hounsfield unit on computed tomography
Imaging studies
