[1]雷腾飞,杜国庆,李正言,等.基于“筋出槽,骨错缝”理论探讨腰骶部结构的影像表现特点与非特异性腰痛关系的临床研究[J].中医正骨,2024,36(08):27-30,51.
 LEI Tengfei,DU Guoqing,LI Zhengyan,et al.Exploring the relationship between imaging features of lumbosacral structure and non-specific low back pain based on the theory of tendon off-position and mild malposition of bone and joint[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(08):27-30,51.
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基于“筋出槽,骨错缝”理论探讨腰骶部结构的影像表现特点与非特异性腰痛关系的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年08期
页码:
27-30,51
栏目:
临床研究
出版日期:
2024-08-20

文章信息/Info

Title:
Exploring the relationship between imaging features of lumbosacral structure and non-specific low back pain based on the theory of tendon off-position and mild malposition of bone and joint
作者:
雷腾飞1杜国庆2李正言2陈博2王辉昊2胡零三2詹红生2
1.深圳平乐骨伤科医院/深圳市坪山区中医院,广东 深圳 518010; 2.上海中医药大学附属曙光医院,上海 201203
Author(s):
LEI Tengfei1DU Guoqing2LI Zhengyan2CHEN Bo2WANG Huihao2HU Lingsan2ZHAN Hongsheng2
1.Shenzhen Pingle Orthopedic Hospital(Shenzhen Pingshan District Hospital of Traditional Chinese medicine),Shen-zhen 518010,Guangdong,China 2.Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China
关键词:
腰痛 腰骶部 筋出槽 骨错缝 影像表现特点 放射摄影术 体层摄影术X线计算机
摘要:
目的:基于“筋出槽,骨错缝”理论探讨腰骶部结构的影像表现特点与非特异性腰痛的关系。方法:纳入60例非特异性腰痛患者(腰痛组)和43例健康志愿者(无腰痛组),拍摄受试者腰椎正侧位X线片和CT片。于腰椎正侧位X线片上分别测量腰骶角、冠状面横骶径、冠状面横髂径,于腰椎横断位CT片上测量横断面横髂径; 并分别计算冠状面横骶径、冠状面横髂径、横断面横髂径的相对值[(右侧径值-左侧径值)/右侧径值×100%]。于腰椎横断位CT片上,采用切线平行法判断L5椎体是否旋转。比较2组受试者的腰骶角、L5椎体旋转发生率,以及冠状面横骶径、冠状面横髂径、横断面横髂径的相对值。将冠状面横骶径、冠状面横髂径、横断面横髂径相对值<-5%定义为左侧相对偏长,将相对值>5%定义为右侧相对偏长,将-5%≤相对值≤5%定义为两侧基本对称。将腰痛组患者按照左侧疼痛、右侧疼痛及双侧疼痛划分,比较不同疼痛侧别患者的腰骶部影像学指标的对称性。结果:腰痛组患者腰骶角小于无腰痛组(t=2.458,P=0.016),冠状面横髂径相对值大于无腰痛组(Z=-2.288,P=0.022),L5椎体旋转发生率高于无腰痛组(χ2=5.589,P=0.018); 2组受试者冠状面横骶径相对值、横断面横髂径相对值的组间比较,差异均无统计学意义(Z=-1.508,P=0.132; Z=-1.817,P=0.069)。腰痛组不同疼痛侧别患者的横断面横髂径对称性比较,差异有统计学意义(χ2=9.309,P=0.011),冠状面横骶径、冠状面横髂径对称性的比较,差异无统计学意义(χ2=0.512,P=0.473; χ2=5.367,P=0.372)。结论:腰骶角变小、L5椎体旋转、冠状面横髂径相对值增大与非特异性腰痛有关,且横断面横髂径对称性与腰痛侧别有关。这些影像表现特点可能是非特异性腰痛患者腰骶部结构“筋出槽,骨错缝”的影像学证据。

参考文献/References:

[1] 中国康复医学会脊柱脊髓专业委员会,中华医学会骨科学分会骨科康复学组.中国非特异性腰背痛临床诊疗指南[J].中国脊柱脊髓杂志,2022,32(3):258-268.
[2] MAHER C,UNDERWOOD M,BUCHBINDER R.Non-specific low back pain[J].Lancet,2017,389(10070):736-747.
[3] DEYO R A,WEINSTEIN J N.Low back pain[J]. N Engl J Med,2001,344(5):363-370.
[4] 靳安民.非特异性腰痛的对因治疗[J].第一军医大学学报,2002,22(12):1057-1060.
[5] SHOKRI P,ZAHMATYAR M,FALAH TAFTI M,et al.Non-spinal low back pain:global epidemiology,trends,and risk factors[J].Health Sci Rep,2023,6(9):e1533.
[6] 雷腾飞,胡零三,安军伟,等.腰骶部“骨错缝、筋出槽”与非特异性下腰痛关系的探讨[J].中国中医骨伤科杂志,2018,26(4):80-82.
[7] 汪敏加,周凌,丁海丽,等.非特异性腰痛患者腰骶结构特征及其影响因素[J].武汉体育学院学报,2017,51(5):95-100.
[8] 潘富伟,邓真,张开勇,等.詹红生从筋诊治非特异性腰痛的临床意义探析[J].上海中医药杂志,2020,54(11):26-28.
[9] 《脊柱筋出槽骨错缝临床诊疗指南》标准化项目专家组.基于德尔菲法构建《脊柱筋出槽疾病诊断标准》专家共识[J].中医正骨,2023,35(3):1-5.
[10] 李正言,丁立鹏,任我行,等.筋出槽和骨错缝的中英文释义及现代认知探讨[J].中医正骨,2024,36(6):37-39.
[11] 杜国庆,沈知彼,李正言,等.脊柱筋出槽、骨错缝疾病临床评估中触诊的价值和操作方法[J].中医正骨,2024,36(2):55-59.
[12] 李伟.正常腰椎及腰椎骨质疏松三维有限元模型的建立及分析[D].石家庄:河北医科大学,2011.
[13] 陈睿,宋恒平.腰骶髂“梯形区”的结构变化在下腰痛中的致因作用[J].中国矫形外科杂志,2011,19(3):260.
[14] 黄清奇,刘少强,梁珪清.腰骶部移行椎的解剖及生物力学研究进展[J].中华外科杂志,2019,57(2):156-160.
[15] 涂强,徐国洲,钟润泉,等.第五腰椎横突肥大综合征的诊断与治疗[J].临床外科杂志,2006,14(6):400-401.
[16] 王震寰,杨其云.腰5—骶1椎间孔的韧带及其与腰腿痛的关系Ⅰ.韧带的解剖学观察[J].颈腰痛杂志,1995,16(4):193-195.
[17] 朱爱国,张烽,朱建炜,等.腰骶丛神经根的应用解剖及临床意义[J].中国组织工程研究,2019,23(4):573-577.
[18] 时蓉,马岳,王云.超声引导下腰骶区神经阻滞技术研究进展[J].中国疼痛医学杂志,2022,28(5):369-374.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目(81473702); 上海市临床重点专科建设项目(shslczdzk03901); 上海市2021高水平地方高效创新团队建设项目(沪教委人〔2022〕3号)
通讯作者:詹红生 E-mail:shgsyjs@139.com
更新日期/Last Update: 1900-01-01