摘要
目的:探讨基于定量计算机断层扫描(QCT)的骨质疏松与腰椎小关节突关节的相关性,以及骨密度(BMD)与小关节各参数的关系,为临床治疗策略的制定提供科学依据。方法:收集2023年12月至2024年3月在辽宁中医药大学附属第二医院骨科因腰部不适及下肢疼痛就诊的63例患者,根据CT腰椎BMD标准,将其分为BMD正常组(31例)、骨量减少组(21例)和骨质疏松组(11例),所有患者均行腰椎CT扫描,扫描完成后采用有体膜模式测量患者BMD、左右关节突面积、CT值、高度等参数,并查看各组是否存在骨赘、终板炎及椎间盘突出;运用单变量方差分析(ANOVA)评估不同BMD组在患者年龄、性别、关节突面积、CT值和高度方面的差异;采用Pathria评分系统对椎间关节的退化进行评估,并利用Fisher精确检验分析3组之间关节突退化评分的差异,同时进行组间两两比较。使用Spearman等级相关性分析探讨BMD与椎间关节退化程度之间的关系。结果:BMD正常组BMD值为(165.14±30.11)mg/cm^(3),骨量减少组BMD值为(98.98±10.14)mg/cm^(3),骨质疏松组BMD值为(58.62±18.73)mg/cm^(3),3组间BMD比较差异有统计学意义(F=103.121,P<0.001),组间两两比较显示,BMD正常组与骨量减少组BMD值比较,差异有统计学意义(t=10.018,P<0.001),BMD正常组与骨质疏松组BMD值比较,差异有统计学意义(t=12.989,P<0.001),骨量减少组与骨质疏松组BMD值比较,差异有统计学意义(t=4.641,P<0.001)。BMD正常组左右上关节突面积均小于其他两组,3组左右上关节突CT值及高度方面差异有统计学意义(F=27.350、24.458,P<0.05);BMD正常组CT值均高于其他两组,骨量减少组右上关节突CT值显著低于骨质疏松组,差异有统计学意义(t=2.191,P<0.05);BMD正常组左右上关节突高度均低于骨质疏松组,右上关节突高度均低于骨量减少组,差异有统计学意义(t=2.332、-2.798、-2.618,P<0.05)。骨质疏松程度与关节突关节退变两者存在负相关性(r=-0.745,P<0.001)。随着BMD值降低,关节突关节的退变随之加重。骨赘、终板炎及椎间盘等比例增加。结论:骨质疏松与腰椎间盘关节突关节退变具有一定相关性,当骨量减少达到严重程度,骨赘、终板炎及椎间盘突出比例均增加,左右关节突面积及高度均增大。
Objective:To study the correlation between osteoporosis and the joint of small articular process of lumbar vertebra,and the correlation between bone mineral density(BMD)and various parameters of small joint based on quantitative computed tomography(QCT),so as to provide scientific basis for formulating clinically treatment strategies.Methods:This study included 63 patients who admitted to orthopedics of The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from December 2023 to March 2024 due to waist discomfort and lower limb pain.According to BMD standard of CT examination for lumbar vertebra,these patients were divided into normal BMD group(31 cases),osteopenia group(21 cases)and osteoporosis group(11 cases).All patients underwent CT scan on lumbar vertebra.The mode with body membrane were adopted to measure BMD,the area of left and right articular process,CT value,height after the scan was completed.Whether existed osteophytes,endplate inflammation and intervertebral disc herniation in each group were checked.Univariate Analysis of Variance(ANOVA)was employed to assess the differences among different BMD groups in age,gender,area of articular process,CT value and height.The Pathria grading system was adopted to assess the degeneration degree of intervertebral joint,and the Fisher's exact test was used to analyze the differences in degeneration scores of articular process among three groups.At the same time,the pairwise comparison between groups also was conducted.Spearman's rank correlation analysis was conducted to explore the correlation between BMD and the degeneration degree of intervertebral joint.Results:The BMD value of normal BMD group was(165.14±30.11)mg/cm^(3),and that of osteopenia group was(98.98±10.14)mg/cm^(3),and that of osteoporosis group was(58.62±18.73)mg/cm^(3).There was a statistically significant difference in BMD value among three groups(F=103.121,P<0.001),and there was a statistically significant difference in BMD value between normal BMD group and osteopenia group as the result of pairwise comparison between groups(t=10.018,P<0.001).There was statistically significant difference in BMD value between normal BMD group and osteoporosis group(t=12.989,P<0.001),and there was statistically significant difference in BMD value between osteopenia group and osteoporosis group(t=4.641,P<0.001).The areas of left and right upper articular process of normal BMD group were less than that of other two groups,and the differences of CT value and height of left and right upper articular process among three groups were significant(F=27.350,24.458,P<0.05),respectively.The CT value of normal BMD group was higher than that of other two groups,and CT values of right upper articular process of osteopenia group was significantly lower than that of osteoporosis group,and the difference was statistical significance(t=2.191,P<0.05).The heights of left and right upper articular processes of normal BMD group were lower than those of osteoporosis group,and the height of right upper articular process was lower than that of osteopenia group(t=2.331,-2.798,-2.618,P<0.05).There was a negative correlation between osteoporosis degree and the degeneration of articular process joints(r=-0.745,P<0.001).With the decreasing of BMD value,the degeneration of articular process joint gradually aggravated,and the ratios of osteophytes,endplate inflammation and intervertebral discs increased.Conclusion:There is a certain correlation between the osteoporosis and the degeneration of articular process joints of lumbar intervertebral disc.The ratios of osteophytes,endplate inflammation and intervertebral disc herniation increase,and both the area and height of the left and right articular process increase when the reduction of bone mass reaches to a serious degree.
作者
李菁菁
李雨桐
梁平
刘家汐
孙巍
高戈
吴涛
Li Jingjing;Li Yutong;Liang Ping;Liu Jiaxi;Sun Wei;Gao Ge;Wu Tao(Department of Radiology,The Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine,Shenyang 110000,China;Division of CT Products,Neusoft Medical Systems Co.Ltd.,Shenyang 110000,China)
出处
《中国医学装备》
2025年第4期53-57,共5页
China Medical Equipment
