影响腰椎滑脱手术复位的影像学预测因素及其临床意义

Radiologic analysis of factors predicting the surgical reduction of lumbar spondylolisthesis

目的研究可以预测腰椎滑脱手术复位疗效的影像学因素。方法2001年5月至2007年4月行后路椎弓根螺钉复位内固定加后外侧融合术并且有完整影像学资料的患者42例，男性11例，女性31例；年龄40-79岁，平均56．0岁。其中退变性滑脱20例，崩裂性滑脱22例。L3,4滑脱1例，L4，5滑脱26例，L5S1滑脱15例。Ⅰ度滑脱23例，Ⅱ度滑脱19例。术前及术后1周常规行腰椎正、侧位X线片检查。在术前侧位X线片上测量滑脱率、椎间隙相对高度、滑脱角、腰前凸角和骶骨倾斜角；在术后侧位片上测量术后滑脱率。对复位率与术前滑脱率、术前滑脱角、术前椎间隙相对高度、术前腰前凸角和术前骶骨倾斜角的关联性采用多元回归分析。结果42例患者术前滑脱率（22．5±10．6）％，术前椎间隙相对高度0．23±0．10，术前滑脱角4．4°±5．4°，术前腰前凸角43°±13°，术前骶骨倾斜角34°±10°，复位率（63．2±27．9）％。复位率与术前滑脱率、术前滑脱角和术前骶骨倾斜角无明显相关性，与术前椎间隙相对高度呈正相关（P〈0．05），与术前腰前凸角呈正相关（P〈0．05）。结论术前椎间隙相对高度和腰前凸角可以预测腰椎滑脱手术复位疗效。

Objectives To find out the radiologic factors predicting the outcomes of reduction of lumbar spandylolisthesis. Methods Forty two patients were treated with pedicle screw fixation with posterolateral fusion because of lumbar spondylolisthesis, with the average age of 56.0 years. There were 11 males and 31 females; 20 degenerative spondylolisthesis cases, and 22 isthmic spondylolisthesis cases; 1 L3,4 case, 26 L4,5 cases and 25 L5S1 cases; 23 grade Ⅰ patients and 19 grade Ⅱ ones. All patients were taken the X-ray examination before operation and one week after operation. Measurements of slip ratio, percentage disc height, slip angle, lumbar lordosis angle and sacral slope angle were based on pre-operation X-rays. Measurements of the post-operation slip ratio were based on post-operation X-rays.Multivariate regression analysis was used to analysis the correlation between reduction ratio and pre-operation slip ratio, slip angle, percentage of disc height, lumbar lordosis angle and sacral slope angle. Results The average pre-operation slip ratio was（22. 5 ± 10. 6） %. The pre-operation percentage disc height was 0. 23 ± 0. 10, the slip angle was d. 4° ±5. 4°, the lumbar lordosis angle was 43° ± 13° and the sacral slope angle was 34° ±10°. The reduction ratio was （63.2 ± 27. 9）%. No correlation was found among reduction ratio with pre-operation slip ratio,slip angle and sacral slope angle, but a positive correlation between reduction ratio and the preoperation percentage of disc height（ P 〈 0. 05 ）, a positive correlation between reduction ratio and the preoperation lumbar lordosis angle （ P 〈 0. 05 ） was found. Conclusion The percentage disc height and the lumbar lordosis angle can predict the outcomes of reduction of lumbar spondylolisthesis.