腰椎滑脱病人站立位及侧卧位腰椎动力X线矢状位曲度比较

Comparison of lumbar sagital plane curves of spondylolisthesis between standing position and lateral lying position dynamic postures

目的:为临床上诊断腰椎不稳或腰椎滑脱选择正确腰椎X线检查方法提供依据。方法:对49例腰椎滑脱病人行腰椎站立位、侧卧位、中立位、最大伸位和屈位状态下侧位X线摄片,测量每例不同状态下的腰椎动力X线矢状位曲度,对所测量的不同状态下腰椎Cobb角度进行统计学比较。结果:49例腰椎滑脱病人三组站立位和卧位腰椎Cobb角:站中NSP(-56.43),卧中NLP(-52.23),t值为3.023,P值为0.006;站屈FSP(-11.87),卧屈FLP(-14.81),t值为-3.091,P值为0.005;站伸ESP(-70.15),卧伸ELP(-67.34),t值为4.284;P值为0.002。即腰椎滑脱Cobb角站立中立位大于侧卧中立位,站立位最大屈位小于侧卧最大屈位,站立位最大伸位大于侧卧最大伸位。结论:站立位的X线检查方法更能反映腰椎病变的实际情况,是临床上诊断腰椎不稳或腰椎滑脱的正确X线检查方法。

To provide the right way of X ray examination in diagnosing spondylolisthesis and lumbar instability. Methods: The lateral lying position and standing position dynamic postures i.e. over-flexure posture, over-extending posture and neutral posture lumbar spine X-rays films of 49 patients with spondylolisthesis were taken. The cobb angles of sagittal plane lumbar spine (from L_1 to S_1) of various posture were measured and statistically evaluated by SPSS software. Results: The cobb angles of L_1～S_1 of over-flexure posture, over-extending posture and neutral posture lumbar spine X-rays films of 49 patients with spondylolisthesis were as followed: NSP (-56.43), NLP (-52.23), tvalue (3.023), Pvalue (0.006); FSP(-11.87), FLP (-14.81), t value (-3.091), Pvalue (0.005); ESP (-70.15), ELP (-67.34), t value (4.284); Pvalue (0.002). It can be found that the cobb angles of L_1～S_1 of neutral posture and over-extending in standing position in spondylolisthesis were bigger than the ones in lying position. The cobb angles of L_1～S_1 of over-flexure posture in standing position were smaller than those of lying position. Conclusion: X-ray examination method in standing position is more proper than the one in lying position.