成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义

The change and clinical significance of sagittal spino-pelvic parameters of adult isthmic spondylolis-thesis

目的：观察成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数的变化，探讨L5入射角与腰椎滑脱程度的相关性。方法：回顾性分析60例L5俗1峡部裂性滑脱患者，年龄28—69岁（平均47．0岁）；以77例年龄（25～63岁，平均43．5岁）匹配的正常成人为对照组。在站立位全脊柱侧位X线片上测量L5滑移距离（slipdistance，SD）、L5滑移百分比（slippingpercentage，SP）以及骨盆入射角（pelvicincidence，PI）、骨盆倾斜角（pelvictilt，胛）、骶骨倾斜角（sacralslope，SS）、L5入射角（L5incidence，L5I）、腰骶角（1umbar-sacralangle，LSA）、腰椎前凸角（1umbarlordosis，LL）、矢状面平衡（sagittalverticalaxis，SVA）等脊柱-骨盆矢状面参数。根据滑移百分比将滑脱组患者分成两组：轻度滑移组（A组，SP≤30％），30例；重度滑移组（B组，SP〉30％），30例。采用独立样本t检验比较滑脱组与对照组及滑脱组内A、B组之间的差异，并用Pearson相关性分析对滑脱患者脊柱一骨盆参数与滑脱程度（SP）进行相关性分析。结果：滑脱组PI、Pr、SS、LL均显著大于正常对照组，LSA显著小于对照组（P〈0．05）。A组L5I与对照组相比无显著差异，B组L5I显著大于对照组（P〈0．05）。B组PI、PT、SS、L5I显著大于A组，LSA显著小于A组（P〈0．05）。滑脱组滑移百分比与PI、PT、SS、SVA均呈正相关，与LSA呈负相关（P〈0．05）。A组滑移百分比与L5I未见显著相关性：B组L5I和SVA与滑移百分比呈显著性正相关（P〈0．05）。滑脱组LSI与PI呈正相关，与LSA呈负相关。结论：成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数与正常人相比PI、PT、SS、LL均较大。滑移百分比大于30％患者的L5I明显增大，并与滑脱程度显著性相关，治疗时应重视对L5I的恢复重建。

Objectives： To investigate the differences of spino-pelvic parameters in patients with isthmic spondylolisthesis of different grades, and the correlation between L5 incidence angle（LSI） and the percentage of spondylolisthesis. Methods： 60 patients with LS-S1 isthmie spondylolisthesis（mean age, 47.0 years; range, 28 to 69 years） and age-matched control group of 77 normal adults（mean age, 43.5 years; range, 25 to 63 years） were recruited in this retrospective study. Parameters including slip distance（SD）, slipping percentage （SP）, pelvic incidence（PI）, pelvic tilt（PT）, sacral slope（SS）, L5 incidenee（LSI）, lumbar-sacral angle（LSA）, lumbar lordosis（LL）, sagittal vertical axis（SVA） were measured on the long-cassette standing upright lateral radiographs of the spine and pelvis. Patients with spondylolisthesis were divided into two groups based on slipping per- centage： group A（low grade） with SP≤30%（30 cases of 60） and group B（high grade） with SP〉30%（30 cases of 60）. Differences in sagittal parameters among groups were analyzed by using independent samples t-test, and Pearsons＇ correlation coefficients were used to investigate the relationship between spino-pelvie parameters and SP. Results： PI, PT, SS, and LL were higher（P〈0.05） in subjects with isthmic spondylolisthesis than those in the control group, while LSA decreased significantly. L5I in group B was significantly higher than that in control group, while there was no significant difference between group A and control group. Strong positive correlation between SP and PI, PT, SS, SVA and negative correlation between SP and LSA were confirmed in all the patients with spondylolisthesis. SP showed a positive correlation with LSI in group B（P〈0.05）, which was the other case in group A. L5I demonstrated a positive correlation with PI and showed a negative rela- tion to LSA in the total isthmic spondylolisthesis group. Conclusions： Spino-pelvic parameters including PI, PT, SS and LL are significantly greater in adult patients with isthmic spondylolisthesis. L5I significantly in- creases in patients with severer spondylolisthesis and shows positive correlation with slipping percentage which indicates that more attention should be paid to the improvement of L5I.