骨盆入射角对成人腰骶部峡部裂滑脱程度和矢状面形态的影响

The influence of pelvic incidence on slip degree and sagittal spino-pelvic alignment of adult lumbosacral isthmic spondylolisthesis

中文关键词:  腰骶部峡部裂性滑脱  骨盆入射角  滑脱程度  矢状面形态

英文关键词:Lumbosacral isthmic spondylolisthesis  Pelvic incidence  Slip degree  Sagittal balance

中文摘要:

  【摘要】 目的：探讨成人腰骶部低度峡部裂性滑脱患者骨盆入射角（pelvic incidence，PI）分布情况及其对滑脱程度和脊柱骨盆矢状面形态的影响。方法：回顾性分析2012年1月～2017年8月在我院就诊的Meyerding分型Ⅰ～Ⅱ度腰骶部峡部裂性滑脱患者的临床资料。按照SDSG滑脱分型中PI分组标准分为低PI组（PI<45°）、中PI组（45°～60°）和高PI组（PI＞60°）。测量的参数包括滑脱率、椎间隙高度、骨盆入射角、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumbar lordosis，LL）、上腰椎前凸角、下腰椎前凸角、胸椎后凸角、矢状面垂直距离（sagittal vertical axis，SVA），同时计算腰椎前凸分布指数（lordosis distribution index，LDI＝下腰椎前凸角/LL）、PT/PI。采用单样本K-S检验本组患者PI分布情况，采用单因素方差分析比较三组之间影像学参数的差异，采用Pearson相关性分析PI与其他参数的关系。结果：共153例患者纳入本研究，其中男50例、女103例，年龄51.7±10.4岁（31～71岁）。腰骶部峡部裂性滑脱患者PI呈正态分布（P=0.20），均值为59.9°±10.5°，低、中和高PI组分别有12（8%）、67（44%）和74（48%）例。低PI组滑脱率明显低于中PI组和高PI组 （P<0.001），而高PI组L5/S1椎间隙高度明显低于其余两组（P<0.05）。低PI组PT、SS、PT/PI、LL、上腰椎前凸角、下腰椎前凸角均显著低于中PI组和高PI组（P<0.01）；而LDI明显高于中PI组和高PI组（P=0.001）。高PI组SVA明显高于低PI组和中PI组（P<0.05）。Pearson相关性分析发现PI与滑脱率、PT、SS、PT/PI、LL、上腰椎前凸角、下腰椎前凸角、SVA成正相关，与LDI呈负相关（P<0.05）。结论：成人腰骶部低度峡部裂性滑脱患者PI呈正态分布，低PI患者滑脱程度较轻，高PI患者腰骶部椎间隙塌陷、滑脱程度重，骨盆后旋导致下腰椎前凸丢失。

英文摘要:

  【Abstract】 Objectives: To evaluate the distribution of pelvic incidence(PI) and its influence on sagittal alignment of lumbosacral isthmic spondylolisthesis(IS). Methods: The consecutive lumbosacral IS patients(Meyerding grade Ⅰ or Ⅱ) between January 2012 and Ａugust 2017 were retrospectively reviewed. According to SDSG slippage PI grouping standard, the enrolled patients were divided into the low PI group(PI<45°), the normal PI group(45°－60°) and the high PI group(PI＞60°). Parameters were measured, including slip percentage, disc height, pelvic incidence, pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), lower lumbar lordosis, upper lumbar lordosis, thoracic kyphosis, sagittal vertical axis(SVA). Meanwhile, lordosis distribution index(LDI=lower lumbar lordosis/LL) and PT/PI were calculated. The above parameters were compared among groups. Results: Totally, 153 patients(50 males and 103 females) were enrolled, with a mean age of 51.7±10.4 years(range, 31-71 years). The PI of cohort had a normal distribution(P=0.2０) and the mean PI was 59.9°±10.5°. There were 12(8%), 67(44%) and 74(48%) patients assigned in the low PI, normal PI and high PI group respectively. The slip degree of low PI group was significantly lower than that of normal PI group and high PI group(P<0.001). The L5/S1 disc height of high PI group was higher than that of the other two groups(P<0.05). PI, PT, SS, PT/PI, LL, lower lumbar lordosis, upper lumbar lordosis in low PI group were statistically lower than that of normal PI group and high PI group(P<0.01). However, LDI of low PI group was significantly higher than that of normal PI and high PI group(P=0.001). Meanwile, SVA of high PI group was higher than that of the other two groups(P<0.05). Positive correlations were found between PI and slip percentage, PT, SS, PT/PI, LL, upper lumbar lordosis, lower lumbar lordosis and SVA, and negative correlations were noted between PI and LDI(P<0.05). Conclusions: The PI of lumbarsacral low-grade IS was normally distributed. The slip degree of lumbarsacral isthmic spondylisthesis is positively correlated with PI. Patients with low PI have mild degree of spondylolisthesis. Patients with high PI have severe degree of spondylolisthesis and remarkable disc collapse, as well as pelvic retroversion.