腰骶部椎体滑脱的生物力学认识和分型

BIOMECHANICAL ANALYSIS AND CLASSIFICATION OF LUMBOSACRAL SPONDYLOLISTHESIS

目的综述腰骶部椎体滑脱发病和发展机制相关方面的研究进展,探讨腰骶部椎体滑脱国际脊柱畸形学会(SDSG)分型方法的实用价值。方法查阅近年与腰骶部椎体滑脱发生和发展机制相关的国内外文献,结合SDSG分型方法综合分析。结果骨盆指数(pelvic incidence,PI)是影响脊柱矢状面平衡和导致腰骶部椎体滑脱产生的关键因素。滑脱Meyerding分度、PI和脊柱-骨盆的平衡情况是影响滑脱是否进展的主要因素,也是影响滑脱治疗方式和预后效果的关键因素。腰骶部椎体滑脱SDSG分型方法与Wiltse、Marchetti-Bartolozzi和Mac-Thiong-Labelle等分型方法相比,组内个体同质性更好,可信度更佳,能更好指导临床治疗和判断预后。结论在临床实践中,宜将SDSG分型方法作为腰骶部椎体滑脱的分型标准。

Objective To review the research progress of the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis, and to discuss the value of Spinal Deformity Study Group （SDSG） classification system for lumbosacral spondylolisthesis. Methods Recent articles about the risk factors for slip progression and the pathogenesis of lumbosacral spondylolisthesis were reviewed and comprehensively analyzed with SDSG classification system of lumbosacral spondylolisthesis. Results Pelvic incidence （PI） is the key pathogenic factor of lumbosacral spondylolisthesis. The Meyerding grade of slip, PI, sacro-pelvic balance, and spino-pelvic balance not only are the fundamental risk factors of slip progression, but also are the key factors to determine how to treat and influence the prognosis. Therefore, compared with Wiltse, Marchetti- Bartolozzi, and Mac-Thiong-Labelle classification systems of lumbosacral spondylolisthesis, SDSG classification based on these factors mentioned above, has better homogeneity between the subjects of subgroup, and better reliability, moreover, could better guide operative plan and judge the prognosis. Conclusion It is suggested that the SDSG classification system should be the standard classification for lumbosacral spondylolisthesis for the clinical and research work.