L5S1椎间盘突出与后关节突发育的关系△

Correlation between L5S1 intervertebral disc herniation and posterior facet process development

摘要:

[目的]分析 L₅S₁椎间盘突出与后关节突发育的关系。[方法]回顾性分析 2017 年—2020 年本科收治的旁侧型椎间盘突出（lumbar disc herniation, LDH）（突出组）患者的临床资料，并收集 107 例腰椎 MRI 无 LDH 作为正常组，分别在 MRI 上测量两组 L₅S₁关节突关节角度（facet joint, FJ）及两组邻近 L_4/5 FJ。计算左右侧 FJ 差值，差值＞10°定义为双侧 FJ 不对称。采用单因素分析和多因素逻辑回归分析 L₅S₁ LDH 的相关影响因素。[结果] 共纳入突出组 102 例，正常组 107 例。单因素分析显示，两组年龄、性别、BMI、L_4/5（ ∠C）、L₅S₁（ ∠C）、L_4/5（ ∣∠α-∠β∣）、L_4/5 不对称的差异均无统计学意义（P＞0.05），但是，突出组 L₅S₁（ ∣∠α-∠β∣） [(10.2±5.4)° vs (4.9±7.6)°, P＜0.001]、L₅S₁ 不对称发生率 [例 (%), 59 (57.8) vs 14 (13.0), P＜0.001]、L_4/5 与 L₅S₁∠C 差绝对值 [(18.0±13.6)° vs (14.1±9.3)°, P=0.016]、L_4/5 与 L₅S₁∠α 差绝对值 [(12.0±8.2)° vs (8.7±5.9)°, P＜0.001]、L_4/5 与 L₅S₁∠β 差绝对值 [(9.4±7.8)° vs (7.4±5.0)°, P=0.026] 显著大于正常组。多因素逻辑回归分析显示，L₅S₁（ ∣∠α-∠β∣）（OR=1.245, P＜0.001）、L_4/5与 L₅S₁∠C 差绝对值（OR=1.049, P＜0.001）是 L₅S₁旁侧型突出的独立危险因素。[结论] L₅S₁旁侧型 LDH 与 L5S₁（ ∣∠α-∠β∣）、L_4/5与 L₅S₁∠C 差绝对值具有相关性。

Abstract:

[Objective] To analyze the relationship between L₅S₁ lumbar disc herniation (LDH) and posterior facetjoint (FJ) development. [Methods] A retrospective analysis was conducted on the clinical data of lateral LDH patients who admitted to our department from 2017 to 2020, additionally, 107 cases of lumbar spine MRI without LDH were collected as the normal group. The FJ angle of L₅S₁ and adjacent L_4/5 were measured on MRI to calculate the difference in FJ between the left and right sides. A difference greater than 10° is defined as bilateral FJ asymmetry. Univariate comparison and multiple factor logistic regression were used to analyze the relevant influencing factors of L₅S₁ LDH. [Results] A total of 102 cases were included in the LDH group, while 107 cases were in the normal group. As results of univariate comparison, there were not significant differences in terms of age, gender, BMI, L_4/5 (∠C), L₅S₁ (∠C), and L_4/5 (∣∠α-∠β∣) and the differences in L_4/5 asymmetry between the two groups (P＞0.05), however, the LDH group proved significantly greater than the normal group regarding to L₅S₁ (∣∠α-∠β∣) [(10.2±5.4)° vs (4.9±7.6)°, P＜0.001], incidence of L₅S₁ asymmetry [cases (%), 59 (57.8) vs 14 (13.0), P＜0.001], absolute difference of ∠C between L_4/5 and L₅S₁ [(18.0 ± 13.6)° vs (14.1±9.3)°, P=0.016], absolute difference of ∠α between L_4/5 and L₅S₁ [(12.0±8.2)° vs (8.7±5.9)°, P＜0.001], absolute difference of ∠β between L_4/5 and L₅S₁ [(9.4±7.8)° vs (7.4 ± 5.0)°, P=0.026]. Multivariate logistic regression analysis showed that the L₅S₁ (∣∠α-∠β∣) (OR=1.245, P＜0.001) and the absolute difference between L_4/5 and L₅S₁ ∠C (OR=1.049, P＜0.001) were the independent risk factors for L₅S₁ lateral LDH. [Conclusion] The L₅S₁ lateral LDH is associated with L₅S₁ (∣∠α-∠β∣) and the absolute difference between L_4/5 and L₅S₁∠C.