第4腰椎退变性滑脱与影像学参数的关系分析

Correlation between the 4th lumbar degenerative spondylolisthesis and radiographic parameters

目的探讨第4腰椎（L。）退变性滑脱（DIS）与影像学参数的关系。方法选取2010年4月至2012年4月收治的L4DLS患者60例作为DIS组，同期年龄与性别相匹配的健康者56例作为对照组。两组研究对象均行腰椎正侧位x线、CT、MRI及骨密度检查。x线上测量椎间盘高度、L4椎体大小、L4椎体倾角、腰椎前凸角及骨盆投射角。cT上测量L3-4、L4-5，头尾侧关节突关节角、关节突关节头尾差角及关节突不对称度。MRI上评估椎间盘退变指数。双能X线吸收法测定骨密度。采用t检验比较两组间各指标的差异，应用Logistic逐步回归分析退变性腰椎滑脱的危险因素。结果DLS组I度滑脱53例，Ⅱ度滑脱7例。滑脱指数为0．174-_0．05。两组间椎间盘高度、椎间盘退变指数、L4椎体大小、L4椎体倾角、腰椎前凸角、骨盆投射角、关节突关节角、骨密度差异均有统计学意义（t=2．28-9．33，P=0．021-0．043）；DIS组L3-4节段关节突关节头尾差角与对照组同节段相比差异有统计学意义（t=3．398和28．122，P=0．000和0．039）。而上述节段的关节突关节不对称度与对照组相比差异无统计学意义（t：0．209～0．465，P：0．295～0．858）。Logistic回归分析显示：L4椎体大小（OR=1．01，95％CI=1．000-1．024，P=0．048）、L4椎体倾角（OR=1．88，95％c，=14．000-14．600，P=0．037）、腰椎前凸角（OR=1．90，95％C1：1．600—15．800，P=0．040）、骨盆投射角（OR=2．58，95％CI=18．000～19．600，P：0．029）及关节突关节角（OR=2．46，95％CI=1．400～16．400，P=0．035）是L。DLS的危险因素。结论DLS组患者具有更小的L4椎体，更大的L4倾角、腰椎前凸角、骨盆投射角及偏向矢状位的关节突关节角，这些可能是DIS的危险因素。

Objective To investigate the relationship between radiographic parameters and the 4th lumbar（L4） degenerative spondylolisthesis. Methods From April 2010 to April 2012,60 patients with the L4 degenerative spondylolisthesis （DLS） were enrolled in DLS group, 56 healthy volunteers were recruited in control group. A series of radiographic parameters were measured in the two groups, including disc height （ DH）, disc degeneration index （ DDI ）, L4 vertebral inclination angle （ L4 -VA ）, pelvic incidence （ PI ）, L4 vertebral size （L4-VS）, lumbar lordosis angle （LLA）, facet joint angulation （FJA） of cephalad and caudad portions, delta FJA of cephlad and caudad portions, asymmetry variation of FJA, bone mineral density （BMD）. Student＇s test was used to compare difference of parameters between two groups. Multivariate logistic regression analysis was used to reveal risk factors of the development of DLS. Results Fifty-three cases of L, spondylolisthesis in DIS group were classified into grade I , 7 cases of L4 spondylolisthesis were classified into grade II. The average Boxall index was 0. 17 ＋ 0. 05. There were significant difference of DH, DDI, L4-VS, L4-VA, LLA, PI, FJA, BMD between DIS group and control group （t = 2. 28-9. 33, P =0. 021-0. 043） . There were significant differences of delta FJA of cephlad and caudad portions in L34, L4.5 between DLS group and control group （ t = 3. 398 and 28. 122, P = 0. 000 and O. 039）. There was nosignificant difference of asymmetry variation of FJA in L3.4, L4.5 between DLS group and control group （ t = 0. 209-0. 465, P = 0. 295-0. 858 ）. Multivariate logistic regression analysis showed that LDS was more frequent among patients with smaller La-VS（ OR = 1. O1,95% CI = 1. 000-1. 024 ,P = O. 048 ） , larger L4-VA （ OR = 1.88,95% CI = 14. 000-14. 600,P = 0. 037 ）, larger LLA （ OR = 1.90,95 % CI = 1. 600-15. 800, P = 0. 040）, larger PI （ OR = 2. 58,95% CI = 18. 000-19. 600,P = 0. 029） and the more sagittal FJA （ OR = 2.46,95%C1= 1.400-16.400,P =O. 035）than those in control group. Conclusions DLS is signifantly correlated with L,-VS. L,-VA. LLA. PI. F.IA. They may be risk factors of the develooment of DLS.