摘要
目的 观察成人退变性腰椎滑脱患者形态学参数和解剖学特征,探讨L4、L5退变性滑脱的差异性。方法 回顾性分析124例退变性腰椎滑脱患者,男20例,女104例;年龄46-70岁（平均49.3岁）;其中L4退变性滑脱103例,L5退变性滑脱21例;以75例年龄43-69岁（平均47.7岁）匹配的正常成人为对照组,男24例,女51例。在站立位全脊柱X线片上测量形态学参数：骨盆入射角（Pelvic incidence,PI）、骨盆倾斜角（Pelvic tilt,PT）、骶骨倾斜角（Sacral slope,SS）、腰椎前凸角（Lumbar lordosis,LL）、胸椎后凸角（Thoracic kyphotic,TK）和矢状面平衡（Sagittal vertical axis,SVA）;解剖学参数：髂骨高度（Iliac crest height,ICH）、骶骨平台角（Sacral table angle,STA）、L4和L5椎体指数（Lumbar index,LI）、L4和L5椎体相对横突长度（Transverse process length,TPL）和横突宽度（Transverse process width,TPW）。采用独立样本检验比较滑脱组与对照组及滑脱组内L4退变组、L5退变组之间的差异。结果 滑脱组脊柱骨盆参数PI、PT、SS、LL和SVA为（57.9±10.3）°、（18.4±7.4）°、（39.9±8.3）°、（54.7±10.9）°和（28.6±18.2）mm,明显正常高于对照组的（43.7±11.6）°、（13.7±6.9）°、（30.2±8.2）°、（48.3±10.1）°和（13.1±19.9）mm（〈0.05）。滑脱组解剖学参数L4TPW、L5TPW、L4LI、L5LI和STA分别为（0.17±0.06）、（0.16±0.04）、（0.84±0.09）、（0.83±0.07）和（89.7±4.8）°,显著低于对照组为（0.25±0.09）、（0.23±0.07）、（0.94±0.06）、（0.92±0.08）和（98.8±3.5）°（〈0.05）,滑脱组L4TPL和L5TPL较正常对照组无显著差异（〉0.05）。滑脱组内,L4DS组和L5DS组ICH分别为（0.67±1.1）和（-1.1±0.98）,L4退变组组ICH值显著高于L5退变组（〈0.05）,其它脊柱骨盆参数和解剖学参数均未见显著差异（〉0.05）。结论腰椎DS发生可能与矢状面形态和腰骶部解剖学特征有关,而DS发生的节段与髂骨高度有关,较高的髂骨则保护了L5使得L4发生滑脱风险增高。
Objective To analyze and compare spino-pelvic andanatomicalparameters of degenerative spondylolisthesis （DS） patients and to assess the differences between the L4 ＆ L5 DS. Methods 124 DS patients （20 males, 104 females） with a mean age of 49.3 years （range, 46 to 70 years） and 75 normal adults （24 males, 51 females） with a mean age 47.7 years （range, 43 to 69 years） were recruited in this retrospective study. DS group contained 103 L4 cases and 21 L5 cases. Spinopelvic and anatomical parameters were analyzed on preoperative full spine x-rays in a standardized standing position. Spinopelvic parameters were measured as following： pelvic incidence, sacral slope, pelvic tilt, lumbar lordosis, thoracic kyphosis, and positioning of the C7 plumb line. Anatomicalparameters were measured as following： iliac crest height, sacral table angle, L4 and L5 transverse process length, L4 and L5 transverse process width, L4 and L5 lumbar index. Differences in sagittal parameters among groups were analyzed by using independent samples t-test. Results The PI, PT, SS, LL and SVA were （57.9±10.3） °, （18.4±7.4） °, （39.9±8.3） °, （54.7±10.9） °and （28.6±18.2） mm respectively, which were significant higher in subjects with DS than those in the control group （43.7±11.6） °, （13.7±6.9） °, （30.2±8.2） °, （48.3±10.1）°and （13.1±19.9） mm）. Compared with the control group, theTPWofL4 （0.17vs0.25, P〈0.05） and Ls （0.19 vs 0.24, P〈0.05） were extremely shorter, the STAwere moreinclined （98.5±vs 90.3±, P〈0.05） and the L1 of L4 （0.84 vs 0.94, P〈0.05） and L5 were lower （0.83 vs 0.92, P〈0.05） in the DS group. On comparison between the L4 and L5 DS groups, there was no difference in all the spino-pelvic parameters （/〉0.05）; Anatomicalparameters such as STA, TPL and TPWdemonstrating no significant difference, while the ICH were significant higher in L4 DS group （0.67vs-1.1, P〈0.05）. Conclusion Morphological and anatomical parameters might be related to the occurrence of degenerative lumbar spondylolisthesis, while the level of vertebral body slippage were more likely associated with the ICH, the ilium with a higher iliac crest act a role in protecting L, from slipping, which predispose the L, vertebra to slip.
作者
陈曦
孙旭
陈忠辉
王斌
刘臻
朱泽章
邱勇
Chen Xi Sun Xu Chen Zhonghui et al(Department of Spine Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical university, Nanjing Jiangsu, 210008, China)
出处
《生物骨科材料与临床研究》
CAS
2016年第5期21-24,28,共5页
Orthopaedic Biomechanics Materials and Clinical Study
基金
第一批10+1南京临床医学中心项目
关键词
退变性腰椎滑脱
髂骨高度
横突宽度
Degenerative spondylolisthesis
lilac crest height
Transverse process width
