影像学分析髂腰韧带与L_5/S_1椎间盘突出及L_5滑脱的力学强度关系

Relationship of mechanical strength of iliolumbar ligament with L_5/S_1 disc herniation and L_5 spondylolisthesis: an imaging analysis

背景:国外与国内研究报道的髂腰韧带形态学特点有很大争议,有关国人髂腰韧带解剖学结构和生物力学特性的报道并不多见,尚未见全面详尽的统计资料。目的:探讨国人L5/S1椎间盘突出及L5滑脱与髂腰韧带的关系。方法:纳入2013年苏州大学附属第一医院正常体检者28例、L5/S1椎间盘突出患者26例及L5滑脱患者26例,正常组男9例、女19例;单纯L5/S1椎间盘突出组男14例、女12例;单纯L5滑脱组男7例、女19例;其中峡部崩裂性滑脱13例、退变性滑脱13例;Ⅰ度滑脱24例、Ⅱ度滑脱2例。在腰椎正位片上测量并计算出各病例L5横突的相对宽度(RT值),并进行对比分析。结果与结论:正常组、单纯L5/S1椎间盘突出组、单纯L5滑脱组年龄、性别差异无显著性意义。正常组RT值大于单纯L5/S1椎间盘突出组、单纯L5滑脱组(P均=0.000);单纯L5/S1椎间盘突出组大于单纯L5滑脱组(P=0.000)。男性、女性患者RT值差异无显著性意义;患者左侧、右侧RT值差异无显著性意义;在L5滑脱的病例中,退变性滑脱患者RT值小于峡部裂性滑脱患者(P=0.004)。提示正常人髂腰韧带强度高于L5/S1椎间盘突出及L5滑脱患者,L5/S1椎间盘突出患者高于L5滑脱患者;峡部裂性滑脱患者髂腰韧带强度高于退变性滑脱患者。髂腰韧带力学强度可能与L5/S1椎间盘突出及L5滑脱病变有关。

BACKGROUND：Studies have shown that morphological characteristics of iliolumbar ligament are controversial. Few Chinese studies concerned anatomical structure and biomechanical features of Chinese iliolumbar ligament, and no detail statistical data were found. OBJECTIVE： To study the relationship of L5/S1 disc herniation and the L5 spondylolisthesis with iliolumbar ligament. METHODS： A total of 28 cases receiving health examination, 26 patients with L5/S1 disc herniation and 26 patients with L5 spondylolisthesis were recruited from First Affiliated Hospital of Soochow University in China in 2013. Normal group contained 9 males and 19 females. L5/S1 disc herniation group contained 14 males and 12 females. L5 spondylolisthesis group contained 7 males and 19 females. Of them, there were 13 cases of spondylolysis and 13 cases degenerative spondylolisthesis; as wel as 24 cases with degree I spondylolisthesis and 2 cases of degree II spondylolisthesis. The relative widths of the L5 transverse process （RT value） on the X-ray of the lumbar vertebra of each case were measured and calculated. RESULTS AND CONCLUSION： No significant difference in age and gender was detected in the normal group, L5/S1 disc herniation group and L5 spondylolisthesis group. RT value was higher in the normal group than in the L5/S1 disc herniation and L5 spondylolisthesis groups （alP=0.000）. RT value was greater in the L5/S1 disc herniation group than in the L5 spondylolisthesis group （P=0.000）. No significant difference in RT value was＆nbsp;detectable between males and females. No significant difference in RT values was visible between the left and right sides. In patients with L5 spondylolisthesis, RT values were lower in the degenerative spondylolisthesis patients than in spondylolysis patients （P=0.004）. Results indicated that the strength of iliolumbar ligament in normal person was higher than that with L5/S1 disc herniation and L5 spondylolisthesis. The strength of iliolumbar ligament in L5/S1 disc herniation patients was higher than that with L5 spondylolisthesis patients. The strength of iliolumbar ligament in spondylolysis patients was higher than that with L5 degenerative spondylolisthesis patients. The mechanical strength of iliolumbar ligament was possibly associated with L5/S1 disc herniation and L5 spondylolisthesis.