成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究

Study of sagittal spino-pelvic morphology in adult degenerative vs isthmic lumbar spondylolisthesis patients

中文关键词:  腰椎滑脱症  峡部裂性  退变性  脊柱骨盆形态  矢状面

英文关键词:Lumbar spondylolisthesis  Isthmic  Degenerative  Spino-pelvic morphology  Sagittal alignment

中文摘要:

  【摘要】 目的：研究成人腰椎峡部裂性滑脱症与退变性滑脱症患者的脊柱骨盆矢状面形态。方法：选择2009年3月~2012年3月就诊且有完整影像学资料的腰椎峡部裂性滑脱症与退变性滑脱症患者共58例，其中峡部裂性滑脱（峡部裂组）29例，男9例，女20例，年龄23~67岁，Ⅰ度滑脱22例、Ⅱ度7例，L4滑脱16例、L5滑脱13例；退变性滑脱（退变组）29例，男5例，女24例，年龄45~85岁，Ⅰ度滑脱22例、Ⅱ度7例，L3滑脱3例、L4滑脱23例、L5滑脱3例。峡部裂组和退变组患者ODI评分分别为25.5分和22.0分，两组间无统计学差异（P＞0.05）。测量两组脊柱骨盆矢状面形态学指标，包括骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumber lordosis，LL）、胸椎后凸角（thoracic kyphosis，TK）、矢状面轴向垂直距离（sagittal vertical axis，SVA）。同时测量两组病例的腰椎滑脱角、滑脱率以及滑脱距离。采用独立样本t检验对两组患者的上述指标进行比较。结果：峡部裂组患者LL、TK和滑脱角分别为52.2°±10.9°、25.3°±11.1°、9.9°±6.4°，明显高于退变组的44.2°±15.4°、23.4°±12.6°、6.0°±3.9°（P＜0.05）；退变组患者SVA为30.6±40.6mm，明显高于峡部裂组的4.6±24.9mm（P＜0.01）。两组患者的骨盆形态学参数PI（峡部裂组53.9°±11.5°，退变组55.8°±10.8°）、PT（17.0°±8.3°，22.9°±7.2°）、SS（36.9°±8.7°，33.4°±9.9°）以及腰椎滑脱率[（21.8±9.8）%，（19.7±7.8）%]、滑脱距离（6.2±2.7mm，5.6±1.9mm）均无统计学差异（P＞0.05）。结论：成人腰椎峡部裂性滑脱症与退变性滑脱症患者具有相似的骨盆形态，但峡部裂性滑脱症患者较退变性滑脱症患者表现为更大的胸椎后凸、腰椎前凸以及滑脱角。

英文摘要:

  【Abstract】 Objectives: To compare the spine and pelvic sagittal morphology between adult degenerative and isthmic lumbar spondylolisthesis. Methods: A total of 58 lumbar spondylolisthesis patients was included in this study, which ranged from March 2009 to March 2012. Long-cassette standing posterior-anterior and lateral radiographs of the spine and the pelvis were obtained from these patients in the fist-on-clavicle position. Isthmic group contained 29 patients(9 males, 20 females), aged from 23 to 67 years, which included 22 degree Ⅰ of slippage and 7 degree Ⅱ of slippage, diseased levels included 16 cases on L4 and 13 cases on L3. Degenerative group contained 29 patients(5 males, 24 females), aged from 45 to 85 years, which included 22 degree Ⅰ of slippage, 7 degree Ⅱ of slippage, diseased levels included 3 cases on L3, 23 cases on L4 and 3 cases on L5. There was no significant difference in Oswestry disability index(ODI) score between adult degenerative and isthmic lumbar spondylolisthesis patients(22.0 vs 25.5, P＞0.05). Pelvic parameters and spine sagittal parameters were as follows: pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), lumber lordosis(LL), thoracic kyphosis(TK), sagittal vertical axis(SVA). Meanwhile, slippage angle, slippage percentage and slippage distance of all patients were measured in radiographys. Based upon independent sample t test, all spino-pelvic parameters between two groups were evaluated and compared. Results: The LL, TK and Slippage angle in isthmic group was 52.2°±10.9°, 25.3°±11.1°, 9.9°±6.4° respectively, which was higher than those in degenerative group respectively(44.2°±15.4°、23.4°±12.6°，6.0°±3.9°，P＜0.05). However, the SVA in degenerative group was higher than that in isthmic group(30.6±40.6mm vs 4.6±24.9mm, P＜0.01). In addition, the pelvic parameters including PI(53.9°±11.5° vs 55.8°±10.8°), PT(17.0°±8.3° vs 22.9°±7.2°), SS(36.9°±8.7° vs 33.4°±9.9°), slippage percentage[（21.8±9.8)% vs (19.7±7.8）%] and slippage distance(6.2±2.7mm vs 5.6±1.9mm) showed no significant difference between two groups(P＞0.05). Conclusions: Compared with degenerative lumbar spondylolisthesis, isthmic spondylolisthesis is of higher TK, LL and Slippage angle. However, pelvic morphology between the isthmic and degenerative lumbar spondylolisthesis is similar.