摘要目的 研究胸腰椎骨折后椎间盘髓核组织进入骨折椎体和患者长期慢性腰背部疼痛的关系.方法 北京大学第三医院骨科在2005年1月至2007年9月期间连续收治的胸腰椎骨折患者中,获得随访且符合人组标准的患者102例,平均随访时间18个月.手术治疗组54例,保守治疗组48例.MRI显示髓核组织进入椎体者为阳性,髓核组织未进入椎体者为阴性.疼痛程度使用视觉模拟评分(VAS)进行评价.采用SAS 9.0统计软件中的Spearman Correlation Coefficients模块和Wileoxon 2-Sample Test模块研究髓核组织进入椎体、治疗方法和后凸角度这三个因素与腰背部疼痛程度的关系.结果 VAS评分手术治疗组阳性患者为3.45±1.23,阴性患者为2.45±1.03;保守治疗组阳性患者为4.11±1.02,阴性患者为2.66±1.20;两组的阳性患者与阴性患者之间VAS评分差异均具有统计学意义,P<0.01.在阳性患者及阴性患者,手术治疗组与保守治疗组之间VAS评分差异均无统计学意义,P>0.05.后凸Cobb角大小与VAS评分的相关系数γ=0.2584,P>0.05.结论 胸腰椎骨折后损伤的椎间盘髓核组织进入骨折椎体与患者伤后长期腰背部疼痛具有相关性.

abstractsObjective To study the correlation between intrusion of nucleus gelatinosus into vertebral body and low back pain after thoracolumbar fractures. Methods One hundred and two patients who were treated in Peking university third hospital from January 2005 to September 2007 were evaluated retrospectively and included into this study. They were followed up for an average of 18 months and complete data were kept. Fifty-four patients were treated operatively and forty-eight patients were treated conservatively. VAS questionnaire was applied to evaluate the low back pairL Spearman CorrelationCoefficients module and Wilcoxon 2-Sample Test module of SAS software were used to analyze the relation between intrusion of nucleus gelatinosns, different treatments, kyphotic Cobb angles and VAS. Results There were strong correlations between intrusion of nucleus gelatinosus and VAS in both operative group, P<0.01 and non-operative group, P<0.01 ; there were poor correlations between different treatments and VAS in both intrusion group, P>0.05 and non-intrusion group, P>0.05; and there were also poor correlations between Cobb angles and VAS, γ=0.2584, P>0.05. Conclusion There is correlation between the intrusion of nucleus gelatinosus into vertebra] body and the low back pain after thoracolumbar fractures.