椎弓完整腰椎滑脱症及其稳定性结构的X线研究

X-ray Study of Lumbar Spindylolysis with Intact Neural Arch and Stability Structure

目的探讨椎弓完整性滑脱症的X线、生物力学特点与退行性腰椎不稳的病理进程.方法对82 例椎弓完整性腰椎滑脱症的正侧位、双斜位X线平片及CT图像(24 例加作CT扫描)进行分析.结果前滑脱68 例(68/82),后滑脱14 例(14/82),共累及84个椎间隙平面.L4～5间隙69个(69/84),L5～S1间隙10个(10/84),L3～4间隙5个(5/84);平片显示椎间隙狭窄53个(53/84),椎间小关节退变72个平面(72/84),两者并存者48个平面(48/84);CT扫描的24个滑脱平面椎间隙,18个平面显示小关节退变(18/24),20个平面出现椎间盘异常(20/24),两者并存者14个平面(14/24).82 例中5 例后部结构未发现X线异常(5/82).结论椎间盘异常和椎间小关节病变为腰椎不稳并导致滑脱的主要病理改变,在病理进程中起主导作用的是其病理力学;而椎间小关节是维系腰椎后部结构稳定性与生物力学功能的关键因素,建议下腰部手术时应尽可能保留后部组织结构.

Objective To discuss the X-ray and biomechanics characteristic of lumbar spondylolisthesis with intact neural arch and analyze the pathological course of degenerate lumbar instability. Methods To analyse X-ray images of lumbar vertebrae positive side and left-right oblique position plain films and CT images （only 24 cases）of 82 patients. Results Among these cases, forward-spondylolysis 68 cases（68/82）, backward-spondylolysis 14 cases（14/ 82）, altogether involved 84 interstice levels; 69 in the L4-5（69/84）, 10 in the L5-S1（10/84）, 5 in the 1.3-4（5/ 84 ）; Plain films shows that interstice straitness were occured in 53 levels （53/84）, intervertebral joint degeneration 72 levels（72/84）, altogether involved 48 levels（48/84）. Among 24 levels scanned by CT, there were 18 levels（18/ 24） of intervertebral joint degeneration, 20 levels （20/24） of intervertebral disc degeneration, altogether involved 48 levels（14/24）. The structure of posterior parts of only 5 patients in 82 patients were not abnormal（5/82）. Conclusion lntervertebral disc and intervertebraljoint degeneration were the pathological course that result in lumbar instability, It＇s pathology mechanics by way of major function in the pathological course; The intervertebral joints were key factor that held together posterior parts stabilization of lumbar and biomechanics function; The writer suggested that the posterior parts of spine should be retained as possible during low lumbar operation.