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R elationship Between Lumbar Disc Herniation and Benign Joint Hypermobility Syndrome
Lomber Disk Hernisi ile Benign Eklem Hipermobilite Sendromu Aras›ndaki ‹liflki
S u m m a r y
O b j e c t i v e : Benign joint hypermobility syndrome (BJHS) can prent with a wide variety of musculoskeletal problems. Lumbar disc herniation (LDH) is a common cau of low back pain. On the other hand, low back pain may be a prenting symptom in patients with BJHS. The purpo of this study was to identify the relationship between BJHS and LDH.
M a t e r i a l s a n d M e t h o d s :The study included 184 patients diagnod with LDH. All patients were assd for existing hypermobility using the revid (Brighton 1998) criteria.
R e s u l t s : The mean age of the patients was 40.9±11.6 years (range: 18-76years); 50 (27.2%) were male and 134 (72.8%) female. The mean Beighton score was 2.04±2.2. Out of 184 cas, 123 (68.4%) had hypermobility according to the revid Brighton criteria. In addition,there was a positive correlation between LDH and BJHS (r=0.15,p=0.0018).
C o n c l u s i o n :We suggest that BJHS may be a risk factor for LHD. As such, BJHS may be considered a concomitant problem in patients with low back pain due to LDH. Turk J Phys Med Rehab 2011;57:85-8.
K e y W o r d s :Benign joint hypermobility syndrome, Beighton score, Brighton criteria, lumbar disc herniation, low back pain
Öz e t
风族
A m a ç: Benign eklem hipermobilite ndromu (BESH) çeflitli kas-iskelet problemleri ile birlikte görülebilir . Lomber disk herniasyonu (LDH) bel a¤-r›s›n›n s›k beplerinden biridir . Benign eklem hipermobilite ndromlu hastalarda bel a¤r›s› bir mptom olabilir . Bu çal›flman›n amac› (BEHS) ile lomber disk hernisi aras›ndaki iliflkiyi göstermektir .
G e r e ç v e Y ön t e m :Çal›flmaya lomber disk hernisi tan›s› konmufl 184hasta dahil edildi. Tüm hastalarda hipermobilite varl›¤›n› de¤erlendir-mek için revize Brighton hipermobilite kriterleri kullan›ld›.
B u l g u l a r : Hastalar›n yafl ortalamas› 40,9±11,6 y›l (18-76 y›l) olup, 50(%27,2) hasta erkek ve 13
4 (%72,8) hasta kad›n idi. Ortalama Beighton skor 2,04±2,2 olup, 123 (%68,4) hasta revize Brighton kriterlerine göre hipermobiliteye sahipti. Ek olarak, lomber disk herniasyonu ile bening eklem hipermobilite ndromu aras›nda pozitif korelasyon tespit edildi.(r=0,15, p=0,0018).
S o n u ç: Sonuç olarak, biz benign eklem hipermobilite ndromunun lomber disk herniasyonu için bir risk faktörü olabilece¤ini düflünmekteyiz. Bunun için, benign eklem hipermobilite ndromu lomber disk herniasyo-nuna ba¤l› bel a¤r›l› bir hastada efllik eden bir durum olabilir .Türk Fiz T›p Rehab Derg 2011;57:85-8.
烫发会导致脱发吗A n a h t a r K e l i m e l e r :Benign eklem hipermobilite ndromu, Beighton skoru, Brighton kriterleri, lomber disk hernisi, bel a¤r›s›
Original Article / Orijinal Makale
‹lknur AKTAfi, Demet OFLUO⁄LU*, Kenan AKGÜN**
Fatih Sultan Mehmet Rearch and Education Hospital Physical Medicine and Rehabilitation Department, Istanbul, Turkey *Baskent University Istanbul Hospital Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
**‹stanbul University Cerrahpafla Faculty of Medicine, Department of Physical Medicine and Rehabilitation, ‹stanbul, Turkey
A d d r e s s f o r C o r r e s p o n d e n c e /Y a z ›flm a A d r e s i : Demet Ofluo¤lu MD, Baskent University Istanbul Hospital Department of Physical Medicine and Rehabilitation, Istanbul,Turkey
Phone:+90 216 554 15 00 E-mail: R
R e c e i v e d /G e l i fl T a r i h i : December/Aral›k 2009 A A c c e p t e d /K a b u l T a r i h i : September/Eylül 2010©Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing. / ©Türkiye Fizikl T›p ve Rehabilitasyon Dergisi, Galenos Y ay›nevi taraf›ndan bas›lm›flt›r .
花样年华台词DOI: 10.4274/tftr .57.17
I n t r o d u c t i o n
Benign joint hypermobility syndrome (BJHS) is a hereditary disorder characterized by the prence of musculoskeletal symptoms in persons with generalized joint laxity in the abnce of systemic rheumatologic dia (1-3). C ollagen fibrils have a relatively thin and irregular structure in patients
with generalized joint hypermobility. This abnormality in the collagen structure leads to laxity of the joints, incread fragility of the connective tissue, and decread proprioception, thereby resulting in a predisposition to joint degeneration and soft tissue injuries (1,4).
The intervertebral disc consists of 3 zones: an outer zone made up of fibrocartilage attaching the other 2 zones to each other; the vertebral body consisting of the central nucleus pulposus (i.e. a fibro-gelatinous mass compod of 80%-90% water, collagen, and a mucopolysaccharide matrix); and the peripheral annulus fibrosus (formed by the concentric alternating lamellae of obliquely oriented collagenous fibers). The annulus fibers run obliquely between vertebrae and are arranged primarily in concentric layers. The annulus is the primary disc structure that resists rotational forces through the orientation of the lamellae. Resistance to forward bending is due to the relatively greater thickness of the posterior lamellae (5-9).
The main function of the intervertebral discs is shock absorption. Primarily, the annulus acts as a shock absorber, not the nucleus, which is predominantly liquid (and incompressible). When an axial load occurs, the incread force on the incompressible nucleus pushes on the annulus and stretches its fibers. If the fibers break, then a herniated nucleus pulposus occurs (10).
Although BJHS is a heritable collagen disorder, the occurrence of herniated nucleus pulposus may be common in patients with this syndrome. We know that excessive spinal joint laxity under mechanical loading in BJHS can lead to a torn annulus fibrosis becau of abnormal annular collagen alignment in the lumbar spinal discs; therefore, the purpo of the prent study was to identify whether or not there is a relationship between BJHS and LDH.
M a t e r i a l s a n d M e t h o d s
P a r t i c i p a n t s
Patients with the complaint of low back pain were prospectively evaluated for LDH and joint hypermobility. LHD diagnosis was bad on patient history (low back, leg, or low back/leg pain, numbness, tingling, paresthesia, etc.), clinical examination, conventional radiography, and magnetic resonance imaging (MRI). The nature of the pain was discusd with the patients (e.g. location and intensity of the pain, aggravating movements, relieving movements, ont and duration of pain, possible caus). In addition, total spinal posture, active/passive range of motion, neurodynamic tests (straight leg raising test, prone knee bending test), and neurological examination of the lower legs were evaluated (11). Peripheral joints (sacroiliac, hip joints, knee joints, ankle joints, foot joints)
were scanned to rule out obvious pathology in the extremities. The patients diagnod with LDH bad on clinical examination and MRI findings (including protrusion, extrusion, and questration) were included in the study. Exclusion criteria were as follows: 1. disc herniation at the level of bulging; 2. history of low back surgery or trauma; 3. sacroiliac dysfunction; 4. inflammatory, infectious, or systemic dia; 5. malignancy; 6. neurological or vascular dia; 7. spondylolisthesis. In addition, routine biochemistry and immunologic laboratory tests were performed when needed to rule out other dias mentioned in the exclusion criteria.
A s s e s s m e n t o f H y p e r m o b i l i t y
The patients were assd for BJHS using the Beighton scoriye (Table 1) and the revid (Brighton 1998) criteria for the diagnosis of BJHS (Table 2) (12). According to Brighton (1998) criteria, the prence of 2 major criteria, 1 major and 2 minor criteria, 4 minor criteria, or 2 minor criteria and findings in first-degree relative(s) are required to establish the diagnosis of BJHS.
S t a t i s t i c a l A n a l y s i s
Statistical analysis was performed using SPSS v.10.0 for Windows. All descriptive analys were performed using this program. Pearson’s correlation coefficient analysis was also performed to deter
mine if there were any correlations between the evaluated parameters.
R e s u l t s
A total of 184 patients were included in the study. The mean age of the patients was 40.9±11.6 years (range: 18-76 years); 50 (27.2%) were male and 134 (72.8%) were female. The mean height and weight of the patients were 164±7.5 cm and 72.7±11.4 kg, respectively. Demographic characteristics of the patients are shown in Table 3. Mean Beighton score was 2.04±2.2. In total, 123 cas (68.4%) had hypermobility bad on the revid (Brighton 1998) criteria.
C orrelation analysis showed that there was a positive correlation between LDH and BJHS (r=0.15, p=0.0018). On the other hand, a negative correlation between height and BJHS (r=–0.21, p=0.001) was obrved, and significantly more of the female patients had BJHS (r=0.28, p<0.001).
D i s c u s s i o n
BJHS can manifest with a wide variety of musculoskeletal symptoms. Typical signs of a connective tissue disorder may be prent, including, scoliosis, back pain, lordosis, pes planus, genu valgum, recurrent dislocation of the joints, and soft tissue rheumatism (13). It has been reported in many stud
ies that there is a relationship between joint hypermobility syndrome and other musculoskeletal dias, such as fibromyalgia, carpal tunnel syndrome, temporomandibular joint dia, and osteoarthritis (14-20). Excessive joint laxity caus wear and tear of joint surfaces as well as strains and fatigue of the soft tissue surrounding the joints.
Low back pain is an extremely common, riously disabling nonfatal public health problem worldwide. In general, 1 of every 3 patients with low back pain has a diagnosis of LDH (21). Risk factors can be divided into 2 major groups: occupational and patient-related (22). Work-related heavy lifting was once the primary suspected risk factor for disc degeneration, which was generally considered to be the result of wear-and-tear exacerbated by the poor nutritional status of the disc. Additionally, lifting, pulling, pushing, and twisting were associated with an increa in the risk (23). Patient-related factors are age,
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Table1. Beighton Scoring for Joint Hypermobility.
gender , anthropometric factors, postural factors, spine mobility,muscle strength,heredity, etc. (24).
BJHS can be associated with many risk factors for LDH. Excessive lumbar spinal mobility and abnormal annular collagen alignment in the lumbar spinal discs can increa the vulnerability of the lumbar spine. To the best of our knowledge,the prent study is the first to evaluate the relationship between LDH and hypermobility. Bad on our results, 68.4% of the cas with LDH had BJHS according to the revid (Brighton 1998) criteria, and there was a positive correlation between LDH and BJHS. In our country, Seckin et al. (25) studied the prevalence of joint hypermobility among healthy students with a mean age
of 15.4 years. According to the Beighton scoring system, joint hypermobility was obrved in 11.7% of their study population;however , the prent study did not include a control group, and we know that the prevalence of generalized joint hypermobility varies from 10% to 30% in the general population (26-28).Overall, women have more joint laxity than men. The prent results support this knowledge. We obrved that the prevalence of BJHS was significantly higher among the female patients; however , 72.8% of our study population was female. The BJHS prevalence rate in the prent study was much higher than that estimated by Seckin et al. (25) for healthy young population. On the other hand, the actual prevalence of BJHS remains unknown.The results of the prent study show that BJHS occurred more commonly in patients diagnod with LDH than in the general population. Our study was like a preliminary study with no control group, although hypermobility was quite higher than that in the normal population.
Although height is excessive in some genetic collagen disorders (such as Marfan dia) as compared to the normal population, in the prent study, there was a negative correlation between height and hypermobility, as reported also by Seckin et al. (25) who hypermobility patients were shorter than their controls.
Determination of hypermobility is especially important in preventive medicine in order to strengthen t
he muscles and therefore prevent further injury resulting from hypermobility,such as overu syndrome. Moreover , strengthening abdominal and back muscles can prevent low back pain. As such, if a patient suffers from low back pain due to LDH, they should also be examined for BJHS.
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可爱图片壁纸
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