[1]李遵旺,郭惠,关雨晴,等.腰椎间盘突出症不同证型腰椎小关节影像学特点及其与证候评分间的相关性研究[J].中国中医骨伤科杂志,2024,32(02):50-55.[doi:10.20085/j.cnki.issn1005-0205.240209]
　LI Zunwang GUO Hui GUAN Yuqing QIN Jiaqi MA Xiaofang LI Dekui.Study on Imaging Characteristics of Lumbar Facet Joints in Different Syndrome Types of Lumbar Disc Herniation and Its Correlation with Syndrome Score[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2024,32(02):50-55.[doi:10.20085/j.cnki.issn1005-0205.240209]
点击复制

腰椎间盘突出症不同证型腰椎小关节影像学特点及其与证候评分间的相关性研究()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第32卷
期数:
2024年02期
页码:
50-55
栏目:
临床研究
出版日期:
2024-02-15

文章信息/Info

Title:
Study on Imaging Characteristics of Lumbar Facet Joints in Different Syndrome Types of Lumbar Disc Herniation and Its Correlation with Syndrome Score
文章编号:
1005-0205(2024)02-0050-06
作者:
李遵旺1; 郭惠2; 关雨晴1; 秦佳齐1; 马小芳1; 李德魁1△
1北京中医药大学东直门医院(北京,100700); 2北京中医药大学第三附属医院
Author(s):
LI Zunwang1 GUO Hui2 GUAN Yuqing1 QIN Jiaqi1 MA Xiaofang1 LI Dekui1△
1Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China; 2Beijing University of Chinese Medicine Third Affiliated Hospital,Beijing 100029,China.
关键词:
腰椎间盘突出症;  中医证型;  腰椎小关节;  证候评分;  相关性
Keywords:
lumbar disc herniation;  TCM pattern;  lumbar facet joints;  syndrome score;  correlation
分类号:
R681.5
DOI:
10.20085/j.cnki.issn1005-0205.240209
文献标志码:
A
摘要:
目的:探讨腰椎间盘突出症不同证型腰椎小关节影像学特点,并分析其与证候评分间的相关性。方法:共纳入265例L3/4和(或)L4/5和(或)L5S1腰椎间盘突出患者,并依据中医诊断标准分为肝肾亏虚组(129例)和气滞血瘀组(136例),评估两组患者腰椎小关节退变程度、腰椎小关节角度及腰椎小关节对称性等影像学参数的各自特征; 用证候评分量表量化两组患者中医证候的严重程度,分析腰椎小关节上述影像学指标与证候评分间的相关性。结果:两组患者腰椎小关节有不同的影像学特征,肝肾亏虚组患者与气滞血瘀组相比,腰椎小关节退变程度更高(P<0.05),腰椎小关节角度趋于矢状化,差异有统计学意义(P<0.05),不对称性更强,差异有统计学意义(P<0.05); 此外肝肾亏虚组证候评分与腰椎小关节退变程度呈显著的正相关,差异有统计学意义(P<0.05); 腰椎小关节角度及不对称性与证候评分间无明显相关性。结论:不同证型的腰椎间盘突出症患者具有不同的腰椎小关节影像学特点,腰椎小关节退变程度也可以反映肝肾亏虚型腰椎间盘突出症患者中医证候程度。
Abstract:
Objective:To explore the radiological characteristics of lumbar facet joints(LFJ)in different patterns of lumbar disc herniation(LDH)and analyze their correlation with traditional Chinese medicine(TCM)syndrome scores.Methods:265 patients with LDH involving the L3/4 and(or)L4/5 and(or)L5S1 segments were included in this study.Patients were divided into two groups based on TCM diagnostic criteria:the liver-kidney deficiency group(129 cases)and the Qi-stagnation and blood stasis group(136 cases).Radiological parameters,including the degree of LFJ degeneration,LFJ angle,and LFJ orientation,were evaluated to determine their characteristics in each group.TCM syndrome severity was quantified using a syndrome score scale,and the correlation between the radiological parameters of the LFJ and syndrome scores was analyzed.Results:The results showed that the LFJ exhibited different radiological features between the two groups.Compared to the Qi-stagnation and blood stasis group,the liver-kidney deficiency group had a higher degree of LFJ degeneration(P<0.05),a tendency towards a more sagittal orientation of the LFJ angle(P<0.05),and stronger asymmetry(P<0.05).Furthermore,there was a significant positive correlation between the syndrome scores of the liver-kidney deficiency group and the degree of LFJ degeneration(P<0.05).However,there was no significant correlation observed between the LFJ angle,asymmetry,and syndrome scores.Conclusion:With different patterns of LDH exhibit distinct radiological characteristics of the LFJ.The degree of LFJ degeneration can also reflect the severity of TCM syndrome in patients with liver-kidney deficiency type LDH.

参考文献/References:

[1] 中国康复医学会脊柱脊髓专业委员会基础研究与转化学组.腰椎间盘突出症诊治与康复管理指南[J].中华外科杂志,2022,60(5):401-408.
[2] 文王强,徐浩翔,张泽佩,等.腰椎小关节退变的相关因素及生物力学特点[J].中国组织工程研究,2020,24(24):3883-3889.
[3] SUN D,LIU P,CHENG J,et al.Correlation between intervertebral disc degeneration,paraspinal muscle atrophy,and lumbar facet joints degeneration in patients with lumbar disc herniation[J].BMC Musculoskelet Disord,2017,18(1):167.
[4] 曹奔,张帅攀,郭光昕,等.基于“筋骨失衡,以筋为先”推拿防治腰椎间盘突出症经验[J].中华中医药杂志,2022,37(3):1504-1507.
[5] 薛彬,宋小慧,许勇,等.李飞跃教授基于“气血失调”和“筋骨失衡”理论诊治腰椎间盘突出症的经验[J].中医正骨,2023,35(2):77-80.
[6] 郭惠,李德魁,李遵旺.腰椎间盘突出症不同证候患者CT影像学特点及其与证候程度间的相关性研究[J].中国CT和MRI杂志,2022,20(12):159-161.
[7] 中华医学会骨科学分会脊柱外科学组,中华医学会骨科学分会骨科康复学组.腰椎间盘突出症诊疗指南(2020年版)[J].中华骨科杂志,2020,40(8):477-487.
[8] WEISHAUPT D,ZANETTI M,BOOS N,MR imaging and CT in osteoarthritis of the lumbar facet joints[J].Skeletal Radiol,1999,28(4):215-219.
[9] LEE D Y,AHN Y,LEE S H.The influence of facet tropism on herniation of the lumbar disc in adolescents and adults[J].J Bone Joint Surg,2006,88(4):520-523.
[10] DEYO R A,MIRZA S K.Herniated lumbar intervertebral disk[J].N Engl J Med,2016,374(18):1763-1772.
[11] KREINER D S,HWANG S W,EASA J E,et al.An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy[J].Spine J,2014,14(1):180-191.
[12] 胡俊翔,包文娟,胡佳,等.揿针联合中药对气滞血瘀型腰椎间盘突出症患者的临床疗效观察[J].中华中医药学刊,2023,41(12):126-129.
[13] 高夕林,岳宝成,潘仁慈,等.独活寄生汤加味联合中医手法治疗腰椎间盘突出症[J].吉林中医药,2022,42(6):733-736.
[14] 蒋位庄,王和鸣.中医骨病学[M].北京:人民卫生出版社,1999:254.
[15] 段戡,邓博,罗毅文,等.腰椎间盘突出症证型分析[J].中国中医骨伤科杂志,2002,10(2):27-29.
[16] SONG Q.Evaluation of MRI and CT parameters to analyze the correlation between disc and facet joint degeneration in the lumbar three-joint complex[J].Medicine(Baltimore),2019,98(40):e17336.
[17] LENG Y,TANG C,HE B,et al.Correlation between the spinopelvic type and morphological characteristics of lumbar facet joints in degenerative lumbar spondylolisthesis[J].Neurosurg Spine,2022,38(4):425-435.
[18] KO S,CHAE S,CHOI W,et al.The prevalence of facet tropism and its correlation with low back pain in selected community-based populations[J].Clin Orthop Surg,2019,11(2):176-182.
[19] GAO F,WU M C.Deep learning-based denoised MRI images for correlation analysis between lumbar facet joint and lumbar disc herniation in spine surgery[J].J Healthc Eng,2021:9687591.
[20] GIUSEPPE L U,ALESSANDRA B,LUCA D,et al.Development of the Italian version of the modified Japanese orthopaedic association score(mJOA-IT):cross-cultural adaptation,reliability,validity and responsiveness[J]. Eur Spine J,2016,25(9):2952-2957.
[21] 张天民,刘建民,王若林.针刀医学对骨质增生的新认识[J].中国医药导报,2017,14(15):156-158.

备注/Memo

备注/Memo:
基金项目:北京中医药大学东直门医院科技创新专项(DZMKJCX-2020-041)
△通信作者 E-mail:ldk05@163.com
更新日期/Last Update: 2024-02-15