退变性和峡部裂性L5/S1滑脱患者L5椎弓根形态学参数比较及其临床意义

Comparison of L5 pedicle morphological parameters between patients with L5/S1 degenerative and isthmic spondylolisthesis and its clinical significance

中文关键词:  峡部裂性腰椎滑脱  退变性腰椎滑脱  椎弓根形态  影像学  相关性

英文关键词:Isthmic lumbar spondylolisthesis  Degenerative lumbar spondylolisthesis  Pedicle morphology  Imaging  Correlation

中文摘要:

  【摘要】 目的：测量退变性和峡部裂性L5/S1滑脱患者的L5椎弓根形态学参数，比较两者的差异并分析其临床意义。方法：收集西南医科大学附属医院2016年1月1日~2020年6月30日收治的L5/S1滑脱症患者的影像学资料，其中峡部裂性L5/S1滑脱119例（IS组），退变性L5/S1滑脱45例（DS组），同时选取164例无腰椎滑脱的腰椎间盘突出症患者作为对照组（NS组）。在多层螺旋计算机断层扫描（MSCT）图像上测量三组患者L5椎弓根的形态学参数，包括椎弓根长度（PL）、椎弓根螺钉轨迹长度（PSTL）、椎弓根宽度（PW）、椎弓根高度（PH）和椎弓根内倾角度（PCA）；在腰椎站立中立侧位X线片上测量L5椎体的滑移距离，并计算滑移百分比。比较三组患者L5椎弓根形态学参数的差异，分析形态学参数与滑移程度的相关性。结果：三组患者性别比、身高、体重和体重指数（BMI）无统计学差异（P>0.05）。三组患者各参数左右侧比较均无统计学差异，合并统计。IS组的PL、PSTL、PW、PH和PCA分别为14.4±2.1mm、48.3±4.2mm、13.6±2.1mm、9.6±1.5mm和29.7°±5.3°；DS组分别为16.2±1.6mm、49.8±3.3mm、11.3±1.9mm、9.7±1.7mm和23.3°±6.5°；NS组分别为15.1±1.7mm、48.5±3.5mm、12.7±1.9mm、10.8±1.3mm和27.3°±4.7°。DS组的PL、PSTL显著性大于IS组（P<0.05），PW和PCA显著性小于IS组（P<0.05），PH两组无统计学差异（P>0.05）。IS组PL、PW、PH、PCA与NS组比较有统计学差异（P<0.05），PSTL与NS组比较无统计学差异（P>0.05）；DS组的PL、PSTL、PW、PH和PCA与NS组比较均有统计学差异（P<0.05）。IS组的滑移距离（11.2±2.7mm）和滑移百分比[（29.1±10.9）%]大于DS组[8.8±2.4mm、（24.4±8.4）%]（P<0.05）。Pearson相关分析结果显示，IS组患者L5椎体滑移百分比和L5椎弓根各参数之间无显著相关性（P>0.05）；DS组患者L5椎体的滑移百分比与PL呈正相关（r=0.640，P=0.0001），与PW（r=-0.510、P=0.0001）和PCA（r=-0.405、P=0.006）呈负相关，与PSTL无显著相关性（P>0.05）。结论：两类滑脱患者滑移椎体椎弓根形态学存在差异，峡部裂性L5/S1滑脱患者的L5椎弓根形态呈“展、短、粗”，退变性L5/S1滑脱患者的L5椎弓根形态呈“收、长、细”。提示两类滑脱患者在椎体滑移发展中椎弓根存在差异性应力重塑。

英文摘要:

  【Abstract】 Objectives: To measure the morphological parameters of L5 pedicle in patients with L5/S1 degenerative and isthmic spondylolisthesis, compare their differences and analyze their clinical significance. Methods: The imaging data of patients with L5/S1 spondylolisthesis admitted to the Affiliated Hospital of Southwest Medical University from January 1, 2016 to June 30, 2020 were collected. There were 119 patients with L5/S1 isthmic spondylolisthesis(IS group) and 45 patients with L5/S1 degenerative spondylolisthesis(DS group), and 164 non- spondylolisthesis patients with lumbar disc herniation were selected as the control group(NS group). The morphological parameters of L5 pedicle of the three groups of patients were measured on multi-slice computed tomography(MSCT) images, including pedicle length(PL), pedicle screw trajectory length(PSTL), pedicle width(PW), pedicle height(PH), and pedicle camber angle(PCA). The slipping distance of L5 vertebra was measured on standing neutral lateral X-ray film, and the percentage of slip was calculated. The differences of L5 pedicle morphological parameters between the three groups were compared, and the correlation between morphological parameters and slip degree was analyzed. Results: There was no significant difference in sex ratio, height, weight and body mass index(BMI) among the three groups of patients(P>0.05). There was no statistical difference between the left and right parameters of the three groups. The PL, PSTL, PW, PH, and PCA of IS, DS, and NS groups were respectively 14.4±2.1mm, 48.3±4.2mm, 13.6±2.1mm, 9.6±1.5mm, and 29.7°±5.3°; 16.2±1.6mm, 49.8±3.3mm, 11.3±1.9mm, 9.7±1.7mm, and 23.3°±6.5°; 15.1±1.7mm, 48.5±3.5mm, 12.7±1.9mm, 10.8±1.3mm, and 27.3°±4.7°. The values of PL and PSTL in DS group were significantly higher than those in IS group(P<0.05), and the values of PW and PCA were significantly smaller than those in IS group(P<0.05), and there was no significant difference in PH between the two groups(P>0.05). There were significant differences in PL, PW, PH, PCA between IS group and NS group(P<0.05), while there was no significant difference of PSTL between these two groups(P>0.05). There were significant differences in PL, PSTL, PW, PH and PCA between DS group and NS group(P<0.05). The slipping distance(11.2±2.7mm) and percentage of slip(29.1±10.9)% of IS group were higher than those in DS group[8.8±2.4mm, (24.4±8.4)%](P<0.05). Pearson correlation analysis showed that there was no significant correlation between the percentage of slip and the parameters of L5 pedicle of IS group(P>0.05); In DS group, the percentage of slip was positively correlated with PL(r=0.640, P=0.0001), and negatively correlated with PW(r=-0.510, P=0.0001) and PCA(r= -0.405, P=0.006), while it has no significant correlations with PSTL(P>0.05). Conclusions: There are differences in the morphology of pedicle of the slipping vertebra between degenerative and isthmic spondylolisthesis. The L5 pedicle morphology in L5/S1 isthmic spondylolisthesis is more abducted, shorter, and wider, while that in the degenerative spondylolisthesis is more adducted, longer, and thinner comparing with the normal populations, suggesting that there is differential stress remodeling of pedicle in the development of spondylolisthesis in patients with the two types of spondylolisthesis.