解剖学因素在退变性腰椎滑脱发生中的意义

The significance of the anatomical factors in the occurrence of degenerative lumbar spondylolisthesis

中文关键词:  退变性腰椎滑脱  腰椎前凸角  椎体指数  椎间盘高度

英文关键词:Degenerative lumbar spondylolisthesis  Lumbar lordosis  Lumbar index  Disc height

中文摘要:

  【摘要】 目的：探讨退变性腰椎滑脱（degenerative lumbar spondylolisthesis, DLS）的解剖学危险因素。方法：以2009年7月~2010年9月在我院确诊的60例DLS患者为观察对象（滑脱组），男20例，女40例，年龄51~75岁，平均65.3±7.8岁，L4滑脱42例，L5滑脱18例。以性别和年龄匹配无DLS的60例健康志愿者为对照（对照组）。在腰椎侧位X线片上测量腰椎前凸角（lumbar lordosis angle, LLA）、骶骨水平角（sacral horizontal angle, SHA）及滑脱节段（对照组取相应节段）的椎体指数（lumbar index, LI）、椎间盘角度（disc angle, DA）、椎间盘高度（disc height, DH），在腰椎正位X线片上测量L5横突的长度（the length of transverse process of L5, TPL）和宽度（the width of transverse process of L5, TPW）。采用t检验比较两组间各指标的差异，应用Logistic逐步回归分析影响退变性腰椎滑脱的解剖学危险因素。结果：滑脱组患者LLA、SHA、LI、DA、DH分别45.83°±10.42°、28.35°±11.16°、0.85±0.13、7.24°±3.83°、9.12±2.73mm；对照组分别为47.48°±10.75°、23.16°±10.68°、0.96±0.10、9.68°±5.54°、10.54±2.48mm，两组间SHA、LI、DA、DH有显著性差异（P＜0.05），LLA无显著性差异（P>0.05）。滑脱组TPL、TPW分别为2.15±0.43cm、1.64±0.41cm，对照组为2.06±0.39cm、1.57±0.32cm，两组间比较无显著性差异（P>0.05）。Logistic回归分析结果显示DLS与LI、DA有显著性相关关系，回归系数分别为－1.693、－1.406。结论：DLS患者的LI下降，DA减小，其可能是DLS的危险因素。

英文摘要:

  【Abstract】 Objectives: To analyzed the risk factors of degenerative lumbar spondylolisthesis(DLS). Methods: Retrospectively reviewed 60 cases of DLS patients as the case group, from July 2009 to September 2010. Male 20 cases, female 40 cases, age 51-75 years old, averaged 65.3±7.8 years old. Enrolled 60 cases age- and sex-matched volunteers without DLS as the control group. The lumber lordosis angle(LLA), sacral horizontal angle(SHA), lumbar index(LI), disc angle(DA), disc height(DH) were measured on the lateral radiograph film and the length of transverse process of L5(TPL), the width of transverse process of L5(TPW) were measured on the anterior-posterior radiograph film. The LI, DA, DH of the control group were the parameter of vertebral and disc, which were corresponding to the slippage level of the case group. Examined the differences of these variables between groups and the association between DLS and these variables. Results: LLA, SHA, LI, DA, DH of the case group were 45.83°±10.42°, 28.35°±11.16°, 0.85±0.13, 7.24°±3.83°, 9.12±2.73mm, and the control group were 47.48°±10.75°, 23.16°±10.68°, 0.96±0.10, 9.68°±5.54°, 10.54±2.48mm. SHA, LI, DA, DH had significant differences between groups(P<0.05). TPL, TPW of the case group were 2.15±0.43cm, 1.64±0.41cm, and TPL, TPW of the control group were 2.06±0.39cm, 1.57±0.32cm. There was no significant difference between groups(P>0.05). Logistic regression analysis showed statistically significant associations between DLS and LI, DA. The regression coefficients of LI and DA were －1.693、－1.406. Conclusions: DLS is significantly correlated with LI and DA. The decline of LI and DA may be the risk factors of DLS.