脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究.docx

1、脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究苏州大学博士学位论文脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究姓名郭炯炯申请学位级别博士专业骨外科学指导教师唐天驷20100301脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究 中文摘要 I脊柱椎间盘退变和骨化性疾病的临床影像学 和流行病学研究 中文摘要 第一部分 中国南方人群中腰椎间盘退变的影像学和流行病学研究 1736例脊柱磁共振图像的研究 【目的】 评估中国南方都市人群中腰椎间盘退行性变化的程度发生率和在不同椎间节段的分布状况。研究椎间盘退变在不同年龄和性别组中的变化。

2、为将来椎间盘退变病因学研究和预防提供依据。 【方法】 通过公开邀请总共有1736例志愿者参加了该研究其中1068例为女性668例为男性年龄范围在8岁至88岁之间平均年龄为38.04岁。对所有参加者进行了影像学检查临床体格检查和症状学评分。用0.2 T和1.5 T的磁共振系统进行脊柱扫描。腰椎T2的矢状位序列成像 TR3000 毫秒 TE 92毫秒 层间距slice thickness5 mm。在所得MRI图像的基础上我们依据新设计的评分系统对腰椎间盘退变和椎间盘凸出进行评分。评估每个腰椎节段的许莫氏结节Schmorl nodes高信号区HIZ和骨髓信号的改变。两位医师共同进行影像学诊断评估。

3、【结果】 许莫氏结节的发生与性别相关许莫氏结节在男性中发生率更高。卡方检验发现许莫氏结节OR : 227.9骨髓信号改变OR : 20.2和高信号区OR : 20.4三种影像学表现与腰椎间盘退变的相关性依次增强均具有高度统计学意义 P0.0005。高信号区和骨髓信号改变与年龄呈显著相关性有高度统计学意义 P0.0005。许莫氏结节和高信号区在腰椎中的分布规律为许莫氏结节从上头端至下尾端呈降序分布椎间盘高信号区从上至下呈升序分布。腰椎间盘退变评分DDD分数和腰椎间盘凸出评分凸出分数与身体质量指数呈正相关有高度统计学意义 P0.0005。我们发现两种腰椎间盘退变评分结果在男女性别间无明显差异。从上

4、头端至下尾端腰椎间盘节段的退变发生呈持续升高趋势。腰椎间盘退变在男女性别之间有一定程度的差异 P0.05。腰椎间盘退变在年轻人群中中文摘要 脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究 II总体发生率高男性中为35.3女性中为33.9。 【结论】 许莫氏结节的发生与年龄因素无关其分布在男女性别之间有明显差异。研究发现腰椎间盘退变在中国南方都市人群中呈高发状态特别是年轻成人中常见。身体质量指数与腰椎间盘退变显著相关。25-35岁年龄段的男性比女性更易患腰椎间盘退变。我们考虑是外界环境因素所致。 【关键词】 腰椎椎间盘退变流行病发生率磁共振 第二部分 腰背痛临床症状与磁共振MRI影像学的相

5、关性研究 【目的】 在中国南方普通都市人群中进行大规模的前瞻性MRI 影像学和临床相关性研究以评估腰背痛腰椎间盘退变影像学表现和其他结果测量指标之间的相关性。 【方法】 椎间盘退变是一生理性变化。在无症状人群中核磁共振影像MRI上也可发现脊柱结构异常。迄今尚无大样本椎间盘退变影像学表现与腰背痛症状的相关性研究。通过公开邀请的方式共有854例志愿者参加了本项临床流行病和影像学研究其中男性294例女性560例年龄在16岁至63岁之间平均36.83岁。所有参加者都进行了腰椎MRI检查并调查了腰背痛和坐骨神经痛的症状特点和严重程度。两位有经验的医师共同评估MRI图像上椎间盘退变和椎间盘凸出的严重程度并

6、进行腰椎间盘退变评分。当腰背痛或坐骨神经痛存在时记录疼痛的持续时间频率和严重度。对样本人群进行疼痛视觉模拟评分VAS伤残功能指数ODIRoland Morris腰背痛功能障碍调查表RMQ和SF-36评分以评估临床疼痛及综合健康情况。 【结果】 腰背痛的临床症状与腰椎MRI上的椎间盘退变和椎间盘突出表现之间有明显的相关性。SF-36评分中的生理功能PF分数疼痛视觉模拟评分VAS腰背痛功能障碍调查表RMQ评估腰背痛效果更灵敏。PF、VAS和ODI与MRI上的腰椎间盘退变表现相关。通过ROC曲线分析发现PFVASODI的ROC曲线下面积分别为0.6070.5960.583。三者可以在一定程度上诊断是

7、否存在椎间盘脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究 中文摘要 III退变但诊断性较弱。单纯坐骨神经痛的志愿者SF-36评分中心理部分分数高于有腰背痛的志愿者。 【结论】 脊柱椎间盘退变在南方都市人群中较为常见。椎间盘影像学退变程度和腰背痛严重性之间有明显的相关性。相比其他评分系统SF-36的生理功能PF评分能更好地评估是否存在腰椎间盘退变和腰背痛的严重程度。单纯坐骨神经痛患者的心理健康状况优于腰背痛患者。虽然环境和身体因素对椎间盘退变有影响但它们的作用程度不同。腰椎间盘退变自然进程可以被行为和环境因素所改变。 【关键词】腰椎腰背痛椎间盘退变临床评分磁共振影像 第三部分 脊柱黄韧带

8、骨化及其合并后纵韧带骨化的流行病学、临床影像学研究和Meta分析 【目的】评估脊柱黄韧带骨化OLF在普通人群中的发生率、形态和分布等流行病学特征并探讨脊柱后纵韧带OPLL合并黄韧带骨化的诊断及治疗。 【方法】 2001年2月至2006年9月间对1736例中国南方人群进行磁共振扫描所有可能的OLF均再行CT检查以证实。根据OLF累及的节段分为单一型连续型非连续型根据矢状位T2像上OLF的形态学特征分为三角形圆形和鸟喙形三种。检索Ovid MedlinePubMedEmbase和中国生物文献数据库1980至2008年搜集全部有关OLF前后联合压迫TOO的病例报道。 【结果】66OLF的流行病学研究

9、和OPLL合并例3.8发现有脊柱OLF。45例68.2的OLF为单一节段21例31.8累及多节段。单一型OLF为45例68.2连续型11例16.7不连续型10例15.2形态学上92个OLF中17个18.5为三角形75个81.5为圆形。OLF最常见于下胸椎其次是上胸椎。纳入研究的OLF流行病学研究共有4篇TOO的报道13篇。所有研究认为TOO首选手术治疗JOA评分适应评估TOO患者的术后疗效。统计学分析显示女性TOO患者的预后劣于男性。在所有检出的TOO病例基础上用二种新的分类法对TOO进行分类。 中文摘要 脊柱椎间盘退变和骨化性疾病的临床影像学和流行病学研究 IV【结论】 OLF在中国南方人群

10、中的发病率约为3.8发生率与年龄和性别相关32的多节段OLF和15的非连续性OLF以及合并TOO发生的可能均提示了全脊柱MRI检查的必要性对于TOO除了治疗责任骨化物外非责任骨化物也要充分考虑减压的可能性新设计的二种OLF和二种TOO分型方法帮助更好地定义和分类OLF、TOO但分型方法能否进一步指导治疗还有待进一步研究。 【关键词】骨化黄韧带后纵韧带前后联合 作 者郭炯炯 指导老师唐天驷 教授 Clinical imaging and prevalence study of degenerative spinal diseases in southern Chinese Abstract VC

11、linical imaging and prevalence study of degenerative spinal diseases in southern Chinese Abstract Part : ?Prevalence and types of abnormalities of the spine in urban southern Chinese: A study of 1736 population MRI scans of the whole spine 【Objective】To estimate the extent prevalence and distributio

12、n of degenerative changes of lumbar disc and some spinal structural abnormalities in an urban population of southern China. This study also determined the variation of these abnormalities in different age and gender groups. 【Methods】A total of 1736 urban southern Chinese volunteers 1068 women 668 me

13、n between 8 and 88 years of age mean 38.04 years were recruited by open invitation. Radiologic examinations clinical interviews and physical examinations were administered to all the participants. T2-weighted 5-mm spin-echo MRI sequences of the whole spine were obtained. On MRIs disc degeneration an

14、d disc bulging were scored using our new methods. Schmorl nodes high intensity zones and marrow changes were assessed for each lumbar segment. The 2 observers reviewed together and settled by consensus differences. 【Results】There was also a significant trend P0.0005 for an overall association betwee

15、n Schmorl nodes and gender higher in men. In chi-square test increasing in the strengths Schmorl nodes marrow changes and HIZ were showed a significant positive association with LDD OR:227.9 20.2 2.4 respectively P0.0005. There was also a statistically significant association between Schmorl nodes a

16、nd marrow changes OR 1.7 P0.05. HIZ and marrow changes showed significant association with ageP0.0005. The distributive sequence of the Schmorl nodes in lumbar in decreasing order is from upper to lower but HIZ is in a reverse order in disc levels. Both DDD and bulge scores showed a significant posi

17、tive association with BMIP0.0005.We found no significant Abstract Clinical imaging and prevalence study of degenerative spinal diseases in southern Chinese VIdifference in both scores between genders. Among the different areas of degeneration there was a consistent increase in prevalence of LDD from

18、 the upper to lower disc levels. There was some variation in LDD across sex groupsP0.05. The prevalence of LDD in younger were also high 35.3 in men and 33.9 in women. 【Conclusions】Schmorl nodes differ greatly between genders and are not age-related changes. A high prevalence of LDD existed in this

19、urban southern Chinese sample. BMI was found to be correlated with LDD. In young adults degenerative disc findings are relatively common. Men aged 25 to 35 years are more likely to have LDD than women. We presumed that is attributed to environmental factors. 【Keywords】degenerative disc disease inter

20、vertebral disc degeneration lumbar prevalence magnetic resonance imaging Part ?: Correlation of MRI abnormalities and low back pain in a population study of 854 subjects 【Objective】 The authors perform a prospective large scale study of quality of life and MRI findings in subjects from a general urb

21、an population of southern China with or without LBP in order to estimate the associations among LBP DDD and some outcome measurements. 【Methods】Intervertebral disc degeneration is part of ageing and abnormalities on MRI scans can be found in asymptomatic individuals. To date there is no large scale

22、population study examining the relationship between MRI findings and symptoms of low back pain LBP. A total of 854 volunteers 560 women 294 men between 16 and 63 years of age were recruited. All underwent a MRI examination of the lumbar spine and answered questions in relation to the presence and se

23、verity of LBP and sciatica. On MRIs the severity of disc degeneration and herniation were scored by 2 experienced clinicians and differences were settled by consensus. Duration frequency and severity of LBP were recorded if present. These subjects were also objectively assessed by the visual analogu

24、e scale VAS Oswestry Disability Index ODI Roland Morris Questionnaire RMQ and SF-36. Clinical imaging and prevalence study of degenerative spinal diseases in southern Chinese Abstract VII【Results】There was significant association between MRI findings of degeneration herniation and LBP. RMQ VAS and p

25、hysical function PF of the SF-36 were better than others as rating scales of LBP. Statistically significant correlations were found between three measurements ODI VAS PF and disc degenerative changes on MRI. ROC curve was used as a quantitative method for assessing a scales ability to distinguish su

26、bjects who have DDD from those who have not. PF VAS and ODI showed significant but weak correlations with DDD. Their areas under ROC curve were 0.607 0.596 and 0.583 respectively. The mental component summary of SF-36 in the subjects who only had sciatica was higher than those who had LBP. 【Conclusi

27、ons】Although conceding that certain structural degenerative abnormalities of the spine are common in general population the present study has been able to show a significant association between DDD and the presence or severity of LBP. PF was relatively a better way to predict the presence of DDD and

28、 rate LBP. 【Keywords】low back pain degenerative disc disease MRI Part ?: Clinical imaging study and meta-analysis of ossification of the ligamentum flavum and posterior longitudinal ligament 【Objective】 To evaluate the prevalence morphology and distribution of ossification of the ligamentum flavum O

29、LF in a population and provide appropriate guidelines for treatment of tandem ossification of the posterior longitudinal ligament OPLL and ligamentum flavum OLF using the method of systematic review. 【Methods】 A total of 1736 southern Chinese volunteers were recruited between February 2001 and Septe

30、mber 2006. Sagittal MRI was administered to all the participants. Presence of OLF was identified and subsequently confirmed by CT scans. The distribution of OLF was classified into three types. While the morphology of the lesion was classified into triangular round and beak shapes. An English and Ch

31、inese literature search from January 1980 to December 2006 was conducted. The key words for search were OLF or OLF and OPLL. 【Results】 OLF was identified in a total of 66 subjects or 3.8 of the population. Abstract Clinical imaging and prevalence study of degenerative spinal diseases in southern Chi

32、nese VIIIThe isolated type was found in 4568.2 cases continuous type in 1116.7 and non-continuous type in 1015.2. The majority of the segments had a round morphology 81.5 while 1718.5 segments were triangular in shape. 4 articles that reported on the prevalence of OLF and 13 reports of tandem OPLL a

33、nd OLF TOO were identified by the detailed review. All studies advocated that the primary therapy for TOO should be operative. The clinical outcomes of surgery were evaluated in most reports predominantly using the JOA scores. A higher rate of women was found in the failure group of TOO. A new two-s