飞行员椎间盘退行性疾病流行病学调查进展

衡伟; 钱济先; 周程沛; 杜明瑞; 魏飞龙; 朱凯龙; 钱澍

doi:10.16766/j.cnki.issn.1674-4152.002910

飞行员椎间盘退行性疾病流行病学调查进展

doi: 10.16766/j.cnki.issn.1674-4152.002910

空军军医大学附属唐都医院骨科，陕西西安 710038

基金项目:

国家自然科学基金项目 81871818

详细信息

通讯作者:
钱澍, E-mail: 465701835@qq.com

中图分类号: R681.53
计量
- 文章访问数: 522
- HTML全文浏览量: 179
- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2022-01-22
- 网络出版日期: 2023-04-19

Epidemiology Research Progress of Degenerative Disc Disease in Pilots

Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi 710038, China

摘要

摘要: 椎间盘退行性疾病是常见的慢性退行性疾病，也是引起颈腰腿痛的首要原因。研究表明，椎间盘自18岁左右开始退变，至中老年以后，由于内外因素的共同影响，椎间盘的生化成分发生改变，导致结构和功能逐渐丧失，从而发生退行性疾病。然而，调查结果表明，椎间盘退行性疾病在飞行员特别是战斗机飞行员中患病率较高，且发病年龄比普通人更早。近年来，随着航空技术的发展，战斗机的性能不断提高，飞行员椎间盘退行性疾病患病率也不断升高，已逐渐成为飞行员主要及常见的疾病之一。在飞行员住院以及改装体检不合格疾病中，椎间盘退行性疾病也高居首位。其中尤以颈椎病、腰椎间盘突出症最为常见，且脊柱生理曲度改变为影像学最常见的早期征象，可作为诊断和干预的依据。此外，根据以往的调查研究发现，椎间盘退变与飞行员年龄、飞行时间以及驾驶的机型有相关性。由椎间盘退行性疾病引起的颈腰背痛极大地影响了飞行员的健康及精神状态，是我军医疗卫生领域的重大难题。本文归纳了近20年国内外对于飞行员特别是高性能战斗机飞行员患椎间盘退行性疾病的流行病学调查研究结果，总结了该人群中椎间盘退行性疾病的发病特征，并加以综述，为研究疾病特征、预测发展趋势、实施防治策略提供有效依据。
- 椎间盘退变 /
- 椎间盘退行性疾病 /
- 飞行员 /
- 流行病学
Abstract: Degenerative disc disease is a common chronic degenerative disease, which is also the primary cause of neck, waist and leg pain. Studies have shown that the intervertebral disc began to degenerate from about 18 years old. In the middle-aged group and elderly, the biochemical composition of the intervertebral disc changes because of the joint influence of internal and external factors, leading to the gradual loss of structure and function, thereby resulting in degenerative diseases. However, investigation results show that the prevalence of degenerative disc disease is higher in pilots, particularly in fighter pilots, and the onset age is earlier than that of ordinary people. In recent years, with the development of aviation technology and the continuous improvement of fighter jets performance, the prevalence of degenerative disc disease in pilots also has been increasing, which has gradually become an important and common disease in pilots. Degenerative disc disease also ranked first amongst the diseases of hospitalisation and of pilots who failed to pass the physical examination. Amongst the diseases, cervical spondylosis and lumbar disc herniation are most common. The changes in spinal physiological curvature are the most common early signs of imaging, which can be used as the basis for diagnosis and intervention. In addition, previous studies have found that intervertebral disc degeneration is related to pilot age, flight duration and type of aircraft flown. Cervical and lumbar back pain caused by degenerative disc diseases has a great impact on the health and mental state of pilots, which is a major problem in the medical and health field of our armed forces. This paper reviews the epidemiological investigation results and characteristics of degenerative disc diseases in pilots, home and abroad in recent 20 years, particularly in high-performance fighter pilots, providing effective basis for the study of disease characteristics, prediction of development trend and implementation of prevention and control strategies.
- Intervertebral disc degeneration /
- Degenerative disc disease /
- Pilot /
- Epidemiology

HTML全文

参考文献(44)

[1]	BAUMGARTNER L, WUERTZ-KOZAK K, LE MAITRE C L, et al. Multiscale regulation of the intervertebral disc: achievements in experimental, in silico, and regenerative research[J]. Int J Mol Sci, 2021, 22(2): 703. doi: 10.3390/ijms22020703
[2]	KOS N, GRADISNIK L, VELNAR T. A brief review of the degenerative intervertebral disc disease[J]. Med Arch, 2019, 73(6): 421-424. doi: 10.5455/medarh.2019.73.421-424
[3]	KIM H S, WU P H, JANG I T. Lumbar degenerative disease part 1: anatomy and pathophysiology of intervertebral discogenic pain and radiofrequency ablation of basivertebral and sinuvertebral nerve treatment for chronic discogenic back pain: a prospective case series and review of literature[J]. Int J Mol Sci, 2020, 21(4): 1483-1510. doi: 10.3390/ijms21041483
[4]	梁家林, 董惠, 金洁, 等. 2009—2018年某中心疗养军事飞行人员疾病谱分析[J]. 华南国防医学杂志, 2019, 33(6): 415-418, 421. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201906015.htm LIANG J L, DONG H, JIN J, et al. Analysis of disease spectrum of military flight crew in a rehabilitative center from 2009 to 2018[J]. Military Medical Journal of South China, 2019, 33(6): 415-418, 421. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201906015.htm
[5]	沈江洁. 2009—2019年某疗养院高性能战斗机飞行员疾病谱分析[J]. 海军医学杂志, 2020, 41(4): 401-403, 410. doi: 10.3969/j.issn.1009-0754.2020.04.017 SHEN J J. Analysis of the disease spectrum for high-performance fighter pilots who stayed in the sanatorium for refreshment from 2009 to 2019[J]. Journal of Navy Medicine, 2020, 41(4): 401-403, 410. doi: 10.3969/j.issn.1009-0754.2020.04.017
[6]	陈孝平, 汪建平, 赵继宗. 外科学[M]. 9版. 北京: 人民卫生出版社, 2018. CHEN X P, WANG J P, ZHAO J Z. Surgery[M]. 9th ed. Beijing: People's Medical Publishing House, 2018.
[7]	衡伟, 杜明瑞, 魏飞龙, 等. 高性能战斗机飞行员椎间盘退变危险因素研究进展[J]. 军事医学, 2021, 45(11): 878-881. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYX202111016.htm HENG W, DU M R, WEI F L, et al. Research advances in risk factors for intervertebral disc degeneration in high performance fighter pilots[J]. Military Medical Sciences, 2021, 45(11): 878-881. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYX202111016.htm
[8]	POSCH M, SCHRANZ A, LENER M, et al. Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study[J]. BMC Musculoskelet Disord, 2019, 20(1): 44-54. doi: 10.1186/s12891-019-2421-7
[9]	马阳光, 张大伟, 上官磊, 等. 不同机种飞行员颈腰痛现况调查及危险因素分析[J]. 空军医学杂志, 2021, 37(6): 465-468, 480. doi: 10.3969/j.issn.2095-3402.2021.06.002 MA Y G, ZHANG D W, SHANGGUAN L, et al. Risk factors of neck and low back pain in pilots of different types of aircraft[J]. Medical Journal of Air Force, 2021, 37(6): 465-468, 480. doi: 10.3969/j.issn.2095-3402.2021.06.002
[10]	张绿圃, 曹小勇, 张胜利, 等. 飞行人员体检疾病谱与住院疾病谱比较分析[J]. 中华航空航天医学杂志, 2018, 29(Z1): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX201212006.htm ZHANG L P, CAO X Y, ZHANG S L, et al. Comparative analysis of medical examination disease spectrum and hospitalization disease spectrum of flight personnel[J]. Chinese Journal of Aerospace Medicine, 2018, 29(Z1): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX201212006.htm
[11]	刘琳, 苏芳, 张莉莉, 等. 2003—2016年空军和陆军飞行人员医学停飞疾病谱分析[J]. 中华航空航天医学杂志, 2020, 31(2): 101-107. doi: 10.3760/cma.j.cn113854-20191211-00098 LIU L, SU F, ZHANG L L, et al. Analysis on disease spectrum of the Air Force and Army flying personnel medical grounded from 2003 to 2016[J]. Chinese Journal of Aerospace Medicine, 2020, 31(2): 101-107. doi: 10.3760/cma.j.cn113854-20191211-00098
[12]	孟凡成, 韩勇, 梁鹏, 等. 中国歼击机飞行员疾病谱Meta分析[J]. 中华航空航天医学杂志, 2021, 32(2): 92-98. doi: 10.3760/cma.j.cn113854-20210119-00009 MENG F C, HAN Y, LIANG P, et al. Meta?analysis of disease spectrum in Chinese fighter pilots[J]. Chinese Journal of Aerospace Medicine, 2021, 32(2): 92-98. doi: 10.3760/cma.j.cn113854-20210119-00009
[13]	曾葭, 易嘉诚, 薛菲, 等. 海军飞行人员改装体检疾病谱和不合格原因分析[J]. 空军医学杂志, 2021, 37(2): 127-130. doi: 10.3969/j.issn.2095-3402.2021.02.010 ZENG J, YI J C, XUE F, et al. Analysis of disease spectrum and unqualified reasons in Naval flight crew physical examination prior to transferring to higher performance aircraft[J]. Medical Journal of Air Force, 2021, 37(2): 127-130. doi: 10.3969/j.issn.2095-3402.2021.02.010
[14]	沈江洁, 吴卉慧, 石桦. 高性能战斗机飞行员运动系统疾病谱分析[J]. 空军医学杂志, 2020, 36(3): 188-190. doi: 10.3969/j.issn.2095-3402.2020.03.002 SHENG J J, WU H H, SHI H. Disease spectrum of motor system in high performance fighter pilots[J]. Medical Journal of Air Force, 2020, 36(3): 188-190. doi: 10.3969/j.issn.2095-3402.2020.03.002
[15]	徐学军, 苏俐, 王建梅, 等. 住院飞行人员骨科疾病谱的调查与对策[J]. 空军医学杂志, 2021, 37(3): 202-204. doi: 10.3969/j.issn.2095-3402.2021.03.005 XU X J, SU L, WANG J M, et al. Orthopedic disease spectrum of hospitalized aircrews[J]. Medical Journal of Air Force, 2021, 37(3): 202-204. doi: 10.3969/j.issn.2095-3402.2021.03.005
[16]	孙景泰, 何劼, 宋明芳, 等. 战斗机飞行员颈椎退行性变调查与致病因素分析[J]. 中国骨与关节损伤杂志, 2013, 28(3): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201303015.htm SUN J T, HE J, SONG M F, et al. Investigation of cervical degeneration and analysis of pathogenic factors in fighter pilots[J]. Chinese Journal of Bone and Joint Injury, 2013, 28(3): 238-239. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201303015.htm
[17]	张晔, 张雷, 孙明举, 等. 高性能歼击机飞行员颈椎病原因调查分析[J]. 海军医学杂志, 2015, 36(4): 298-299. doi: 10.3969/j.issn.1009-0754.2015.04.005 ZHANG Y, ZHANG L, SUN M J, et al. Investigation and analysis of the causes of cervical spondylosis in high performance fighter pilots[J]. Journal of Navy Medicine, 2015, 36(4): 298-299. doi: 10.3969/j.issn.1009-0754.2015.04.005
[18]	SOVELIUS R, SALONEN O, LAMMINEN A, et al. Spinal MRI in fighter pilots and controls: a 13-year longitudinal study[J]. Aviat Space Environ Med, 2008, 79(7): 685-688. doi: 10.3357/ASEM.2249.2008
[19]	MILLER C A, BOULTER J H, COUGHLIN D J, et al. Return-to-active-duty rates after anterior cervical spine surgery in military pilots[J]. Neurosurg Focus, 2018, 45(6): 1-6. doi: 10.3171/2018.9.FOCUS18491
[20]	郑勇明, 董海波. 腰椎间盘突出症患者严重程度与CT影像学特征的相关性分析[J]. 中华全科医学, 2019, 17(3): 447-450. doi: 10.16766/j.cnki.issn.1674-4152.000705 ZHENG Y M, DONG H B. Analysis of the correlation between severity of clinical symptoms and CT imaging features in patients with lumbar disc herniation[J]. Chinese Journal of General Practice, 2019, 17(3): 447-450. doi: 10.16766/j.cnki.issn.1674-4152.000705
[21]	侯立松. 脊柱内镜下不同入路椎间盘摘除术治疗胸腰段椎间盘突出症疗效对比[J]. 中国烧伤创疡杂志, 2020, 32(5): 363-367. doi: 10.3969/j.issn.1001-0726.2020.05.016 HOU L S. Discectomies from different approaches under the spinal endoscopy in the treatment of thoracolumbar disc herniation[J]. The Chinese Journal of Bums Wounds & Surtace Ulcers, 2020, 36(5): 363-367. doi: 10.3969/j.issn.1001-0726.2020.05.016
[22]	张荷, 骆芝英, 蔡文杰, 等. 330例海军飞行员腰椎椎间盘磁共振成像结果分析[J]. 中华航空航天医学杂志, 2022, 33(2): 109-113. doi: 10.3760/cma.j.cn113854-20211117-00164 ZHANG H, LUO Z Y, CAI W J, et al. Analysis of MRI screening results of lumbar intervertebral disc in 330 naval pilots[J]. Chinese Journal of Aerospace Medicine, 2022, 33(2): 109-113. doi: 10.3760/cma.j.cn113854-20211117-00164
[23]	闫彩, 吴海洋, 周杰, 等. 疗养飞行人员年度体检情况分析[J]. 中华保健医学杂志, 2018, 20(6): 522-523. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJB201806024.htm YAN C, WU H Y, ZHOU J, et al. Analysis of annual medical examinations of convalescent flight personnel[J]. Chinese Journal of Health Care and Medicine, 2018, 20(6): 522-523. https://www.cnki.com.cn/Article/CJFDTOTAL-JFJB201806024.htm
[24]	崔丽, 徐先荣, 郑军, 等. 军事飞行人员医学停飞疾病谱10年回顾分析[J]. 空军医学杂志, 2021, 37(3): 194-198. doi: 10.3969/j.issn.2095-3402.2021.03.003 CUI L, XU X R, ZHENG J, et al. Disease spectrum of permanent grounding in military aircrews: a 10-year review[J]. Medical Journal of Air Force, 2021, 37(3): 194-198. doi: 10.3969/j.issn.2095-3402.2021.03.003
[25]	周磊, 范茂丹, 黄峰, 等. 1 184名飞行人员疗养期间检出疾病谱分析及对策建议[J]. 西南国防医药, 2019, 29(11): 1130-1132. doi: 10.3969/j.issn.1004-0188.2019.11.014 ZHOU L, FAN M D, HUANG F, et al. Analysis of the disease spectrum detected during the convalescence of 1184 flight personnel and suggestions for countermeasures[J]. Medical Journal of National Defending Forces in Southwest China, 2019, 29(11): 1130-1132. doi: 10.3969/j.issn.1004-0188.2019.11.014
[26]	全军航空航天医学专业委员会, 卫杰, 郑超, 等. 军事飞行人员腰椎间盘突出症医学鉴定操作指南(2022)[J]. 空军军医大学学报, 2022, 43(5): 546-549. PLA Society of Aerospace Medicine. Guidelines for medical evaluation of lumbar disc herniation in military pilots(2022)[J]. Journal of Air Force Medical University, 2022, 43(5): 546-549.
[27]	RAPAŁA K, BRYCHCY A, WALCZAK P, et al. NMR scan of the lumbar spine-clinically asymptomatic-in candidates for pilots of the military aircrafts[J]. Polish Journal of Aviation Medicine and Psychology, 2011, 17(3): 241-249.
[28]	谭权昌, 蒋继亮, 闫浩, 等. 军事飞行员下腰部疼痛的研究进展[J]. 中华航空航天医学杂志, 2018, 29(Z1): 258-263. TAN Q C, JIANG J L, YAN H, et al. Research progress on low back pain of military pilots[J]. Chinese Journal of Aerospace Medicine, 2018, 29(Z1): 258-263.
[29]	于利锋, 蒋继乐, 郭杰, 等. 斜外侧腰椎椎间融合术联合后路固定与单独应用对退行性滑脱节段力线改善效果的比较[J]. 中国临床医学, 2022, 29(4): 649-653. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202204022.htm YU L F, JIANG J L, GUO J, et al. Comparison of segmental alignment outcomes in lumbar degenerative spondylolisthesis after single OLIF and OLIF with posterior fixation[J]. Chinese Journal of Clinical Medicine, 2022, 29(4): 649-653. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202204022.htm
[30]	李婉丽, 林艳, 彭德清, 等. Orem自理模式联合回馈式教学在退行性腰椎滑脱手术患者中的应用[J]. 安徽医学, 2022, 43(7): 843-846. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202207024.htm LI W L, LIN Y, PENG D Q, et al. Orem self-care model combined with feedback teaching in patients undergoing surgery for degenerative lumbar spondylolisthesis[J]. Anhui Medical Journal, 2022, 43(7): 843-846. https://www.cnki.com.cn/Article/CJFDTOTAL-AHYX202207024.htm
[31]	陈名智, 伍骥, 朱克顺, 等. 飞行员腰椎椎弓根峡部裂的医学鉴定[J]. 中华航空航天医学杂志, 2006, 17(4): 309-313, 337. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHK200604018.htm CHENG M Z, WU J, ZHU K S, et al. Medical assessment of pilots with lumbar isthmus spondylolysis[J]. Chinese Journal of Aerospace Medicine, 2006, 17(4): 309-313, 337. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHK200604018.htm
[32]	WEI F L, LIU Y, ZHOU C P, et al. Management for lumbar spinal stenosis: protocol for a network meta-analysis and systematic review[J]. J Orthop Surg(Hong Kong), 2020, 28(3): 2309499020975212. DOI: 10.1177/2309499020975212.
[33]	ROMEO V, COVELLO M, SALVATORE E, et al. High prevalence of spinal magnetic resonance imaging findings in asymptomatic young adults (18-22 yrs) candidate to air force flight[J]. Spine(Phila Pa 1976), 2019, 44(12): 872-878.
[34]	孙涛, 邱小洪, 李建平, 等. 高G载荷下飞行员颈椎生理曲度异常分析[J]. 中国疗养医学, 2015, 24(4): 430-431. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201504052.htm SUN T, QIU X H, LI J P, et al. Analysis of cervical spine physiological curvature abnormalities in pilots under high G load[J]. Chinese Journal of Convalescent Medicine, 2015, 24(4): 430-431. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201504052.htm
[35]	蒋瑞静, 张金龙, 马晓璇, 等. 歼击机飞行员改装体检脊柱磁共振成像结果分析[J]. 空军医学杂志, 2021, 37(6): 478-480. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZY202106005.htm JIANG R J, ZHANG J L, MA X X, et al. Results of spinal magnetic resonance imaging of fighter pilots during physical examination for modified aircraft[J]. Medical Journal of Air Force, 2021, 37(6): 478-480. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZY202106005.htm
[36]	王键, 梁明龙, 李扬, 等. 单中心飞行人员腰椎MRI影像学检查结果分析[J]. 中华航空航天医学杂志, 2021, 32(1): 7-11. WANG J, LIANG M L, LI Y, et al. Study on the lumbar MRI image results of flying personnel in a single? center[J]. Chinese Journal of Aerospace Medicine, 2021, 32(1): 7-11.
[37]	何劼, 季军, 田建全, 等. 军队飞行人员颈腰疾病流行病学调查分析[J]. 华南国防医学杂志, 2019, 33(6): 407-410. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201906012.htm HE J, JI J, TIAN J Q, et al. Epidemiological investigation of cervical and lumbar diseases in military flight personnel[J]. Military Medical Journal of South China, 2019, 33(6): 407-410. https://www.cnki.com.cn/Article/CJFDTOTAL-HNGY201906012.htm
[38]	KNOX J B, DEAL J B, KNOX J A. Lumbar disc herniation in military helicopter pilots vs. matched controls[J]. Aerosp Med Hum Perform, 2018, 89(5): 442-445.
[39]	邱晨生, 邓念, 相宏飞, 等. 椎间盘退变相关危险因素的研究进展[J]. 中华骨科杂志, 2021, 41(10): 654-659. QIU C S, DENG N, XIANG H F, et al. Research progress of associated risk factors in intervertebral dise degeneration[J]. Chinese Journal of Orthopaedics, 2021, 41(10): 654-659.
[40]	李中正, 邱联波. 军队飞行员腰椎间盘突出症病因分析及预防保健[J]. 中国疗养医学, 2018, 27(1): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201801045.htm LI Z Z, QIU L B. Analysis of the etiology of lumbar disc herniation and preventive care for military pilots[J]. Chinese Journal of Convalescent Medicine, 2018, 27(1): 103-104. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201801045.htm
[41]	YANG Y Z, LIU S, LING M Y, et al. Prevalence and potential risk factors for occupational low back pain among male military pilots: a study based on questionnaire and physical function assessment[J]. Front Public Health, 2022, 9: 744601. DOI: 10.3389/fpubh.2021.744601.
[42]	张秀兰, 钱勇, 田雨, 等. 磁共振T1rho成像在定量检测飞行人员早期椎间盘退变中的应用价值[J]. 临床放射学杂志, 2018, 37(7): 1177-1181. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201807029.htm ZHANG X L, QIAN Y, TIAN Y, et al. T1rho imaging quantification of early intervertebral disc degeneration in pilots on 3.0 T magnetic resonance[J]. Journal of Clinical Radiology, 2018, 37(7): 1177-1181. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201807029.htm
[43]	VERDE P, TRIVELLONI P, ANGELINO G, et al. Neck pain in F-16 vs. Typhoon fighter pilots[J]. Aerosp Med Hum Perform, 2015, 86(4): 402-406.
[44]	孙涛, 王超, 刘兆强. 高载荷(+Gz)作用对高性能战斗机飞行员腰椎退变的影响[J]. 中国疗养医学, 2015, 24(3): 312-314. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201503054.htm SUN T, WANG C, LIU Z Q. Effect of high load (+Gz) on lumbar spine degeneration in high-performance fighter pilots[J]. Chinese Journal of Convalescent Medicine, 2015, 24(3): 312-314. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGLX201503054.htm