成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义

The change and clinical significance of sagittal spino-pelvic parameters of adult isthmic spondylolisthesis

中文关键词:  腰椎滑脱  脊柱-骨盆参数  L5入射角

英文关键词:Spondylolisthesis  Spinopelvic sagittal parameters  L5 incidence

中文摘要:

  【摘要】 目的：观察成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数的变化，探讨L5入射角与腰椎滑脱程度的相关性。方法：回顾性分析60例L5/S1峡部裂性滑脱患者，年龄28~69岁（平均47.0岁）；以77例年龄（25~63岁，平均43.5岁）匹配的正常成人为对照组。在站立位全脊柱侧位X线片上测量L5滑移距离（slip distance，SD）、L5滑移百分比（slipping percentage，SP）以及骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt， PT）、骶骨倾斜角（sacral slope，SS）、L5入射角（L5 incidence，L5I）、腰骶角（lumbar-sacral angle，LSA）、腰椎前凸角（lumbar lordosis，LL）、矢状面平衡（sagittal vertical axis，SVA）等脊柱-骨盆矢状面参数。根据滑移百分比将滑脱组患者分成两组：轻度滑移组（A组，SP≤30%），30例；重度滑移组（B组，SP>30%），30例。采用独立样本t检验比较滑脱组与对照组及滑脱组内A、B组之间的差异，并用Pearson相关性分析对滑脱患者脊柱-骨盆参数与滑脱程度（SP）进行相关性分析。结果：滑脱组PI、PT、SS、LL均显著大于正常对照组，LSA显著小于对照组（P<0.05）。A组L5I与对照组相比无显著差异，B组L5I显著大于对照组（P<0.05）。B组PI、PT、SS、L5I显著大于A组，LSA显著小于A组（P<0.05）。滑脱组滑移百分比与PI、PT、SS、SVA均呈正相关，与LSA呈负相关（P<0.05）。A组滑移百分比与L5I未见显著相关性；B组L5I和SVA与滑移百分比呈显著性正相关（P<0.05）。滑脱组L5I与PI呈正相关，与LSA呈负相关。结论：成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数与正常人相比PI、PT、SS、LL均较大。滑移百分比大于30%患者的L5I明显增大，并与滑脱程度显著性相关，治疗时应重视对L5I的恢复重建。

英文摘要:

  【Abstract】 Objectives: To investigate the differences of spino-pelvic parameters in patients with isthmic spondylolisthesis of different grades, and the correlation between L5 incidence angle(L5I) and the percentage of spondylolisthesis. Methods: 60 patients with L5-S1 isthmic spondylolisthesis(mean age, 47.0 years; range, 28 to 69 years) and age-matched control group of 77 normal adults(mean age, 43.5 years; range, 25 to 63 years) were recruited in this retrospective study. Parameters including slip distance(SD), slipping percentage(SP), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), L5 incidence(L5I), lumbar-sacral angle(LSA), lumbar lordosis(LL), sagittal vertical axis(SVA) were measured on the long-cassette standing upright lateral radiographs of the spine and pelvis. Patients with spondylolisthesis were divided into two groups based on slipping percentage: group A(low grade) with SP≤30%(30 cases of 60) and group B(high grade) with SP>30%(30 cases of 60). Differences in sagittal parameters among groups were analyzed by using independent samples t-test, and Pearsons′ correlation coefficients were used to investigate the relationship between spino-pelvic parameters and SP. Results: PI, PT, SS, and LL were higher(P<0.05) in subjects with isthmic spondylolisthesis than those in the control group, while LSA decreased significantly. L5I in group B was significantly higher than that in control group, while there was no significant difference between group A and control group. Strong positive correlation between SP and PI, PT, SS, SVA and negative correlation between SP and LSA were confirmed in all the patients with spondylolisthesis. SP showed a positive correlation with L5I in group B(P<0.05), which was the other case in group A. L5I demonstrated a positive correlation with PI and showed a negative relation to LSA in the total isthmic spondylolisthesis group. Conclusions: Spino-pelvic parameters including PI, PT, SS and LL are significantly greater in adult patients with isthmic spondylolisthesis. L5I significantly increases in patients with severer spondylolisthesis and shows positive correlation with slipping percentage which indicates that more attention should be paid to the improvement of L5I.