青少年L5滑脱患者脊柱-骨盆矢状面形态的特征及临床意义

Characteristics and clinical significance of spine-pelvic sagittal morphology of adolescent L5 spondylolisthesis

中文关键词:  青少年腰椎滑脱  峡部裂  发育不良  矢状面平衡  脊柱-骨盆参数

英文关键词:Adolescents lumbar spondylolisthesis  Spondylolysis  Dysplasia  Sagittal balance  Spino-pelvic parameters

中文摘要:

  【摘要】 目的：研究青少年L5滑脱患者的脊柱-骨盆矢状面形态，分析不同类型滑脱的矢状面参数特征及临床意义。方法：回顾性分析2010年1月~2019年12月在我院就诊的资料完整的青少年L5滑脱患者36例，男、女各18例，平均年龄14.1±2.5岁（10~18岁）；按照Wiltse滑脱分型分为峡部裂组28例和发育不良组8例；按照Meyerding分度标准分为轻度滑脱组32例（Ⅰ度29例、Ⅱ度3例）和重度滑脱组4例（Ⅲ度2例、Ⅳ度2例）。在站立位全长脊柱侧位片上测量脊柱-骨盆矢状面参数。其中滑移参数包括：滑脱率（slip rate，SR）、滑脱角（slip angle，SA）；骨盆矢状面参数包括：骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、腰骶角（lumbosacral angle，LSA）、骶骨平台角（sacral table angle，STA）；脊柱矢状面参数包括：胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）和矢状垂直偏距（sagittal vertical axis，SVA）。对比研究峡部裂组和发育不良组以及轻度和重度滑脱患者的脊柱-骨盆矢状面参数特点和相关临床意义。结果：峡部裂组SR=（13.7±8.1）%，PT=15.7°±8.3°，LSA=105.9°±11.8°，STA=102.8°±6.5°；发育不良组SR=（42.4±27.8）%，PT=34.2°±9.6°，LSA=78.7°±11.2°，STA=76.4°±9.5°；两组相比具有显著的统计学差异（P<0.05）。轻度滑脱组SR=（14.4±7.8）%，PT=18.1°±10.4°，LSA=102.1°±15.5°，STA=99.9°±10.8°；重度滑脱组SR=（65.0±19.6）%，PT=33.9°±11.1°，LSA=77.4°±6.7°，STA=77.7°±8.8°，两组相比具有显著的统计学差异（P<0.05）。峡部裂组SA=2.6°±13.1°，PI=54.6°±9.0°，TK=23.5°±15.5°，LL=-53.0°±18.3°；发育不良组SA=11.2°±10.5°，PI=60.8°±14.5°，TK=21.5°±14.3°，LL= -45.3°±15.9°；两组相比无统计学差异（P>0.05）。轻度滑脱组SA=3.3°±12.6°，PI=55.3°±10.4°，TK=24.0°±13.1°，LL=-52.7°±17.4°；重度滑脱组SA=14.5°±12.8°，PI=61.0°±12.2°，TK=14.8°±3.7°，LL=-40.0°±20.0°，两组相比无统计学差异（P>0.05）。结论：青少年L5滑脱中，发育不良性多为重度滑脱，而峡部裂性多为轻度滑脱。发育不良性重度滑脱容易出现矢状面失衡和滑脱进展，其脊柱-骨盆矢状面呈现躯干前倾，骶骨垂直和骨盆后倾的形态。

英文摘要:

  【Abstract】 Objectives: To study the sagittal spinopelvic morphological characteristics of adolescent with L5 spondylolisthesis, and analyze the sagittal parameters and clinical significance of different types of spondylolisthesis. Methods: Retrospective analysis was performed on adolescent patients with L5 spondylolisthesis treated in our hospital from January 2010 to December 2019. Of all 36 patients with intact medical data, there were 18 males and 18 females with an average age of 14.1±2.5 years (10-18 years). According to Wiltse classification, the patients were divided into isthmic type (28 cases) and dysplasia type (8 cases). According to Meyerding classification, 32 cases were mild spondylolisthesis (29 cases were of grade Ⅰ and 3 cases were of grade Ⅱ) and 4 cases were severe spondylolisthesis (2 cases were of grade Ⅲ and 2 were of grade Ⅳ). The sagittal spinopelvic parameters were measured on the standing lateral full-length spine radiograph, among which were slip parameters including slip rate (SR) and slip angle (SA); sagittal parameters of the pelvis including pelvic incidence (PI), pelvic tilt (PT), lumbosacral angle (LSA), and the sacral table angle (STA); spinal sagittal parameters including thoracic kyphosis (TK), lumbar lordosis (LL) and sagittal vertical axis (SVA). The sagittal spinopelvic parameters of isthmic and dysplastic group as well as mild and severe group were compared. Results: SR=(13.7±8.1)%, PT=15.7±8.3°, LSA=105.9±11.8° and STA=102.8±6.5° in isthmic type; SR=(42.4±27.8)%, PT=34.2°±9.6°, LSA=78.7±11.2° and STA=76.4±9.5° in dysplastic type. The difference between the two groups was statistically significant(P<0.05). SR=(14.4±7.8)%, PT=18.1°±10.4°, LSA=102.1°±15.5° and STA=99.9°±10.8° in mild spondylolisthesis; SR=(65.0±19.6)%, PT=33.9°±11.1°, LSA=77.4°±6.7° and STA=77.7°±8.8° in severe spondylolisthesis. The difference between the two groups was statistically significant(P<0.05). SA=2.6°±13.1°, PI=54.6°±9.0°, TK=23.5°±15.5° and LL=-53.0°±18.3° in isthmic type; SA=11.2°±10.5°, PI=60.8°±14.5°, TK=21.5°±14.3° and LL=-45.3°±15.9° in dysplastic type; there was no statistical difference between the two groups(P>0.05)。SA=3.3°±12.6°, PI=55.3°±10.4°, TK=24.0°±13.1° and LL=-52.7°±17.4° in mild spondylolisthesis; SA=14.5°±12.8°, PI=61.0°±12.2°, TK=14.8°±3.7° and LL=-40.0°±20.0° in severe spondylolisthesis, with no statistical difference between the two groups(P>0.05). Conclusions: In L5 spondylolisthesis of adolescents, most of the dysplasia type is severe spondylolisthesis, while the isthmus type is mild spondylolisthesis. Severe spondylolisthesis of dysplasia is prone to sagittal imbalance and progress of spondylolisthesis. The sagittal plane of spine pelvis presents the forward sloping trunk, the sacrum is vertical and the pelvis is inclined backward.