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| 慢性腰腿痛患者骨密度与腰椎间盘退变严重程度的相关性分析 |
| Correlation analysis between bone mineral density and severity of lumbar disc degeneration in patients with chronic lumbocrural pain |
| 投稿时间：2025-09-29 修订日期：2025-11-17 |
| DOI： |
| 中文关键词: 骨密度 腰椎间盘退变 慢性腰腿痛 Pfirrmann分级 相关性 |
| 英文关键词:bone mineral density lumbar disc degeneration chronic lumbocrural pain Pfirrmann classification correlation |
| 基金项目:国家自然科学基金面上项目(82474529) |
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| 中文摘要: |
| 【】目的 探讨慢性腰腿痛患者骨密度(bone mineral density, BMD)与腰椎间盘退变(lumbar disc degeneration, LDD)严重程度的相关性,为临床评估及疾病预测提供参考。方法 采用回顾性分析方法,纳入2021年1月—2022年5月诊治的443例慢性腰腿痛患者,其中男性137例、女性306例,患者平均年龄(64.40±14.08)岁(20~96岁),平均体质量指数(BMI)(23.17±3.66)kg/m2(12.10~37.60 kg/m2)。采用双能X线骨密度仪检测患者腰椎(L1~L4)、左侧髋关节及左侧股骨颈BMD(以T值表示),依据WHO标准分为骨量正常组、骨量减少组及骨质疏松(osteoporosis, OP)组。其中,全身BMD分组以腰椎L1~L4、左侧股骨颈、左侧髋关节中任一部位BMD T值≤-2.5为OP诊断依据；腰椎BMD分组以腰椎 L1~L4平均BMD为依据。采用Pfirrmann分级系统评估腰椎(L1~S1)各节段椎间盘MRI T2加权像退变程度,计算患者平均LDD评分。比较不同组间LDD评分差异,采用Spearman相关性分析腰椎BMD、左侧股骨颈BMD、左侧髋关节BMD与LDD的关系。结果 根据全身BMD分组结果显示:OP组及骨量减少组患者年龄均大于骨量正常组,BMI均小于骨量正常组,且女性占比均高于骨量正常组、男性占比均低于骨量正常组(均P＜0.05)。基于腰椎平均BMD、左侧股骨颈BMD及左侧髋关节BMD的分组LDD评分比较结果显示:除腰椎骨量减少组L5/S1节段退变评分与腰椎骨量正常组比较差异无统计学意义(P＞0.05)外,其余三种分组中,OP及骨量减少组LDD评分均高于骨量正常组(均P＜0.05)。相关性分析显示:左侧股骨颈BMD、左侧髋关节BMD及腰椎(L1~L4)BMD均与LDD程度呈负相关(r值分别为-0.489、-0.478、-0.418,均P=0.000),即慢性腰腿痛患者BMD越低,LDD程度越严重。结论 在慢性腰腿痛患者中,BMD降低与LDD严重程度显著相关,BMD越低,LDD程度越严重。这表明系统性骨代谢异常可能与椎间盘退行性病变存在共同的病理过程。 |
| 英文摘要: |
| Objective ：This study aimed to investigate the correlation between bone mineral density (BMD) and the severity of lumbar disc degeneration (LDD) in patients with chronic lumbocrural pain, so as to provide a reference for clinical evaluation and disease prediction. Methods：A retrospective analysis was conducted on 443 patients with chronic lumbocrural pain who were diagnosed and treated from January 2021 to May 2022. Among them, there were 137 males and 306 females, with a mean age of (64.40±14.08) years (range: 20–96 years) and a mean body mass index (BMI) of (23.17±3.66) kg/m2 (range: 12.10–37.60 kg/m2). Dual-energy X-ray absorptiometry (DXA) was used to measure the BMD (expressed as T-score) of the lumbar spine (L1–L4), left hip joint, and left femoral neck. According to the World Health Organization (WHO) criteria, patients were divided into three groups: normal bone mass group, osteopenia group, and osteoporosis (OP) group. For the systemic BMD grouping, a diagnosis of OP was made if the BMD T-score of any one of the three sites (lumbar spine L1–L4, left femoral neck, left hip joint) was ≤ -2.5; for the lumbar spine BMD grouping, the mean BMD of the lumbar spine L1–L4 was used as the basis. The Pfirrmann classification system was applied to assess the degeneration severity of intervertebral discs at each segment of the lumbar spine (L1–S1) on MRI T2-weighted images, and the mean LDD score of each patient was calculated. Differences in LDD scores among different groups were compared, and Spearman correlation analysis was used to explore the relationships between LDD and BMD of the lumbar spine, left femoral neck, and left hip joint. Results ：The results of systemic BMD grouping showed that: compared with the normal bone mass group, the osteopenia group and OP group had older ages, lower BMI, higher proportion of females, and lower proportion of males (all P<0.05). For the LDD score comparisons based on the three grouping methods (lumbar spine mean BMD, left femoral neck BMD, and left hip joint BMD), no statistically significant difference was observed in the L5/S1 segment degeneration score between the lumbar osteopenia group and the lumbar normal bone mass group (P>0.05); however, in the other comparisons across the three groupings, the LDD scores of the osteopenia group and OP group were significantly higher than those of the normal bone mass group (all P<0.05). Correlation analysis revealed that BMD of the left femoral neck, left hip joint, and lumbar spine (L1–L4) was negatively correlated with the severity of LDD (r=-0.489, -0.478, and -0.418, respectively; all P=0.000). Specifically, the lower the BMD of patients with chronic lumbocrural pain, the more severe the LDD. Conclusion ：In patients with chronic lumbocrural pain, reduced BMD is significantly correlated with the severity of LDD, and the lower the BMD, the more severe the LDD. This suggests that systemic bone metabolism disorders and intervertebral disc degeneration may share common pathological mechanisms. |
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