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目的:分析腰椎间盘突出症患者突出椎间盘及相邻椎间盘的术前MRI表现,评估其退变程度。方法:回顾性分析2014年6月~2015年12月在宁夏医科大学总医院脊柱骨科已行手术治疗的的单节段腰椎间盘突出症患者100例,其中男56例,女44例,年龄23~79岁(51.68±5.60岁),将所有患者以10年为一年龄段进行分组。突出椎间盘发生在L4/5节段50个,其相邻椎间盘100个;L5/S1节段50个,其相邻椎间盘50个。观察术前腰椎MRI,椎间盘采用Pfirrmann分级标准进行评估;软骨终板形态以Pappou分级标准进行评估。年龄段间的比较采用单因素方差分析,相邻椎间盘与退变椎间盘间的相关性采用Pearson相关分析,相邻椎间盘间的比较采用t检验。结果:各年龄段L4/5、L5/S1突出椎间盘的Pfirrmann分级均在Ⅲ级以上、Pappou分级均在Ⅱ级以上,各年龄段间椎间盘退变结果有统计学差异(P<0.05);而各年龄段间软骨终板退变结果无统计学差异(P>0.05)。各年龄段间突出椎间盘发生在L4/5、L5/S1的上位相邻椎间盘Pfirrmann分级有统计学差异(P<0.05),下位相邻椎间盘Pfirrmann分级各年龄段无统计学差异(P>0.05),相邻椎间盘软骨终板退变结果各年龄段间无统计学差异(P>0.05)。相邻的L3/4椎间盘Pfirrmann分级与突出的L4/5椎间盘Pfirrmann分级有相关性(r=0.696,P=0.000),相邻L5/S1椎间盘Pfirrmann分级与突出L4/5椎间盘Pfirrmann分级间无相关性(r=0.214,P=0.136);相邻的L3/4、L5/S1椎间盘软骨终板形态Pappou分级与突出的L4/5椎间盘软骨终板形态Pappou分级均有相关性(r=0.467,P=0.001;r=0.380,P=0.007)。相邻L4/5椎间盘的Pfirrmann分级与突出L5/S1椎间盘的Pfirrmann分级有相关性(r=0.549,P=0.000);相邻L4/5椎间盘软骨终板形态Pappou分级与突出L5/S1椎间盘的软骨终板形态Pappou分级有相关性(r=0.684,P=0.001)。L4/5椎间盘突出的相邻L3/4椎间盘Pfirrmann分级和软骨终板形态Pappou分级评分分别为3.26±0.87分、1.54±0.50分,均高于相邻L5/S1椎间盘的2.96±0.59分、1.23±0.49分(P<0.05)。结论:腰椎间盘突出症患者突出节段的相邻椎间盘及软骨终板的退变与年龄及突出椎间盘退变程度关系密切,且相邻上位椎间盘较下位椎间盘退变更明显。
OBJECTIVE: To analyze preoperative MRI manifestations of lumbar disc herniation in patients with herniated discs and adjacent intervertebral discs and assess the degree of degeneration. Methods: A retrospective analysis of 100 patients with single segmental lumbar disc herniation was performed in the Department of Vertebral Orthopedics, General Hospital of Ningxia Medical University from June 2014 to December 2015. There were 56 males and 44 females, aged 23 ~ 79 years (51.68 ± 5.60 years), all patients were grouped into 10-year-old age groups. Disc herniation occurred in the L4 / 5 segment of 50, the adjacent disc 100; L5 / S1 segment 50, adjacent disc 50. The preoperative lumbar MRI was observed. The disc was evaluated by Pfirrmann grading. The cartilaginous endplate morphology was evaluated by Pappou grading. One-way ANOVA was used to compare age groups. Pearson correlation analysis was used to analyze the correlation between adjacent intervertebral discs and degenerative intervertebral discs. The t-test was used to compare the adjacent intervertebral discs. Results: The Pfirrmann grade of L4 / 5 and L5 / S1 disc herniation in all age groups was above grade Ⅲ, Pappou grade was above grade Ⅱ, and the result of intervertebral disc degeneration was statistically significant (P <0.05). There was no significant difference in degeneration of cartilage endplate between all age groups (P> 0.05). Pfirrmann grade of the adjacent superior intervertebral disc between L4 / 5 and L5 / S1 was statistically significant (P <0.05), while Pfirrmann grade of the inferior intervertebral disc had no significant difference (P> 0.05) There were no significant differences in the degenerative results of adjacent disc cartilage endplate among all age groups (P> 0.05). The Pfirrmann grading of the adjacent L3 / 4 intervertebral disc was correlated with the Pfirrmann grading of the prominent L4 / 5 intervertebral disc (r = 0.696, P = 0.000). There was no correlation between the Pfirrmann grading of the adjacent L5 / S1 intervertebral disc and the Pfirrmann grading of the prominent L4 / (R = 0.214, P = 0.136). The Pappou grading of adjacent L3 / 4, L5 / S1 intervertebral disc cartilage and Pappou grading of the prominent L4 / 5 intervertebral disc cartilage were correlated (r = P = 0.001; r = 0.380, P = 0.007). The Pfirrmann grade of adjacent L4 / 5 intervertebral discs was correlated with the Pfirrmann grade of prominent L5 / S1 intervertebral discs (r = 0.549, P = 0.000). The adjacent L4 / 5 intervertebral disc cartilage endplate Pappou grading and the prominent L5 / S1 intervertebral disc Cartilage endplate morphology Pappou grade correlation (r = 0.684, P = 0.001). The Pfirrmann grading and Pappou grading of the L4 / 5 intervertebral disc adjacent to the L3 / 4 intervertebral disc were 3.26 ± 0.87 and 1.54 ± 0.50, respectively, which were higher than those of the adjacent L5 / S1 disc 2.96 ± 0.59 and 1.23 ± 0.49 (P <0.05). Conclusion: The degeneration of the adjacent intervertebral disc and cartilage endplate in the protruding segment of lumbar disc herniation is closely related to the age and the degree of degenerative disc herniation, and the degeneration of the adjacent lower intervertebral disc is more obvious.