【摘要】：研究證實,四肢骨關(guān)節(jié)中骨關(guān)節(jié)炎和骨質(zhì)疏松之間存在反向的相關(guān)關(guān)系:骨關(guān)節(jié)炎越嚴重,骨密度就越高,即骨質(zhì)疏松的程度越輕。椎體骨質(zhì)疏松和椎間盤退變是常見的脊柱疾患,然而腰椎骨密度與腰椎間盤之間的確切關(guān)系迄今仍然存在著廣泛爭議。既往研究多認為腰椎骨密度越高,腰椎間盤退變越嚴重;相反地,也有研究發(fā)現(xiàn)骨質(zhì)疏松患者更可能出現(xiàn)腰椎間盤退變。腰椎骨密度與腰椎間盤退變的相關(guān)性研究受到骨密度測量的部位和技術(shù)、椎間盤退變的測量方法以及研究對象等諸多因素的影響。明確腰椎骨密度和腰椎間盤退變的相關(guān)關(guān)系,對于理解脊柱疾患,特別是老年性脊柱疾患的病因、發(fā)生、發(fā)展過程有重要的理論意義。目的:探討不同人群腰椎骨密度與腰椎間盤退變的相關(guān)關(guān)系。方法:本研究選取2012年1月至2015年9月期間,在浙一醫(yī)院因腰腿疼痛就診的165例腰椎疾患病人、在邵逸夫醫(yī)院常規(guī)體檢的161例體檢者以及來自杭州采荷社區(qū)的186例志愿者,所有入選樣本均有腰椎磁共振(MR)和DXA腰椎骨密度檢查。其中,186例社區(qū)志愿者同時測量了髖部骨密度。在腰椎MRT2像,Pfirrmann 5級評分法評估腰椎間盤退變、改良的Weishaupt3級評分法評估關(guān)節(jié)突關(guān)節(jié)退變。多因素回歸分析不同人群骨密度與年齡、性別、體重指數(shù)、腰椎區(qū)域、關(guān)節(jié)突關(guān)節(jié)退變以及腰椎間盤退變的相關(guān)關(guān)系。結(jié)果:本研究共納入512例樣本。腰椎疾患組165例,其中男性30例,女性135例,年齡49～102歲,平均69.9±8.7歲;體檢組161例,其中男性117例,女性44例,年齡31～76歲,平均48.8±8.6歲;社區(qū)志愿者組186例,其中男性109例,女性77例,年齡24～87歲,平均50.8±15.5歲。體檢組和社區(qū)志愿者組在年齡、性別比例以及腰椎骨密度均無明顯差異,因此將兩組合并為"一般人群組"。單因素分析顯示,年齡越大,腰椎間盤退變(Coef.=0.03,P0.01)和關(guān)節(jié)突關(guān)節(jié)退變(Coef.=0.01,P0.01)越嚴重。腰椎間盤退變與關(guān)節(jié)突關(guān)節(jié)退變呈正相關(guān)(Coef.=0.26,P0.01)。在腰椎疾患組和一般人群組中,腰椎骨密度與年齡均呈負相關(guān)(腰椎疾患組Coef.=-0.02,P0.01;一般人群組Coef.=-0.04,P0.01),與體重指數(shù)均呈正相關(guān)(腰椎疾患組 Coef.=0.01,P0.01;一般人群組 Coef.=0.01,P0.01)。在一般人群組中,多因素分析納入年齡、性別、體重指數(shù)和腰椎區(qū)域后發(fā)現(xiàn):腰椎骨密度與嚴重的腰椎間盤退變(Pfirrmann評分為V)呈正相關(guān)關(guān)系(Coef.=0.26,P0.05);進一步將關(guān)節(jié)突關(guān)節(jié)退變納入多因素回歸,腰椎骨密度與腰椎間盤退變的相關(guān)關(guān)系消失(P0.05),而與關(guān)節(jié)突關(guān)節(jié)退變呈正相關(guān)(Coef.=0.12,P0.01)。在腰椎疾患組中,腰椎骨密度與腰椎間盤之間未見統(tǒng)計學(xué)相關(guān)關(guān)系(P0.05)。在186例有髖部骨密度的一般人群中,髖部骨密度與腰椎間盤退變之間無相關(guān)關(guān)系(P0.05)。結(jié)論:本研究未觀察到腰椎骨密度與腰椎間盤退變之間存在相關(guān)關(guān)系,骨密度可能不是腰椎間盤退變的危險因素。關(guān)節(jié)突關(guān)節(jié)退變干擾腰椎骨密度的測量,可能混淆腰椎骨密度與腰椎間盤退變的相關(guān)關(guān)系。
[Abstract]:The study confirms that there is a reverse correlation between osteoarthritis and osteoporosis in the extremities: the more severe osteoarthritis, the higher the bone density, the less the degree of osteoporosis. Vertebral osteoporosis and disc degeneration are common spinal disorders, but the exact relationship between the bone density of the lumbar spine and the lumbar intervertebral disc still remains. The higher the bone density of the lumbar spine, the more severe the lumbar intervertebral disc degeneration; on the contrary, the study found that the patients with osteoporosis are more likely to have lumbar disc degeneration. The correlation between the lumbar bone density and lumbar disc degeneration is studied by the site and technique of the measurement of bone density, and the method of measuring the degeneration of the intervertebral disc. The relationship between lumbar bone density and lumbar intervertebral disc degeneration has important theoretical significance for understanding the etiology, occurrence and development of spinal disorders, especially for senile spinal disorders. Objective: To explore the relationship between lumbar bone density and lumbar intervertebral disc degeneration in different groups. From January 2012 to September 2015, 165 patients with lumbar disease were diagnosed with lumbago and leg pain in Zhejiang one hospital. 161 cases of routine physical examination in Sir Run Run Shaw Hospital and 186 volunteers from Hangzhou mining community were selected. All the selected samples were examined by lumbar magnetic resonance (MR) and DXA lumbar bone density examination. Among them, 186 cases of community volunteering were voluntary. The bone mineral density of the hip was measured at the same time. The lumbar MRT2 image, Pfirrmann 5 grade evaluation was used to evaluate the lumbar intervertebral disc degeneration, and the improved Weishaupt3 grade evaluation was used to evaluate the articular process degeneration. Results: 512 samples were included in this study. There were 165 cases in the lumbar disease group, including 30 males and 135 females, 49~102 years old and 69.9 8.7 years old, and 161 cases in the physical examination group, including 117 men, 44 women, 31~76 years of age, and average 48.8 + 8.6 years. .8 + 15.5 years old. There was no significant difference in age, sex ratio and lumbar bone mineral density in the physical examination group and the community volunteer group. Therefore, the two groups were merged into the "general population group". Single factor analysis showed that the older the age, the more severe the lumbar intervertebral disc degeneration (Coef.=0.03, P0.01) and the articular process (P0.01) were more serious. The lumbar disc degeneration and joint process were more serious. The joint degeneration was positive correlation (Coef.=0.26, P0.01). In the lumbar disease group and the general population group, the lumbar bone density was negatively correlated with age (Coef.=-0.02, P0.01, Coef.=-0.04, P0.01) in the lumbar disease group (Coef.=-0.04, P0.01), and was positively correlated with the body mass index (Coef.=0.01, P0.01; Coef.=0.01, P0.01) in the general group. In the population group, multifactor analysis was included in age, sex, body mass index and lumbar region: the lumbar bone density was positively correlated with the severe lumbar disc degeneration (Pfirrmann score V) (Coef.=0.26, P0.05), and the regression of the articular process was further included in the regression of the multifactorin, and the correlation between the lumbar bone density and the lumbar disc degeneration was related. There was a positive correlation between the loss of (P0.05) and articular process degeneration (Coef.=0.12, P0.01). In the lumbar disease group, there was no statistical correlation between the lumbar bone density and the lumbar intervertebral disc (P0.05). There was no correlation between the hip bone density and the lumbar disc degeneration (P0.05) in 186 cases with hip bone density (P0.05). Conclusion: This study was not observed. There is a correlation between lumbar bone density and lumbar intervertebral disc degeneration. Bone density may not be a risk factor for lumbar intervertebral disc degeneration. The measurement of lumbar intervertebral bone density interfered with articular process degeneration may confuse the correlation between lumbar bone density and lumbar disc degeneration.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R681.5

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