峡部裂性与退变性腰椎滑脱MSCT扫描解剖学因素的对照研究

Anatomical Factors for Isthmic Spondylolisthesis and Degenerative Spondylolisthesis:a Comparison with MSCT

目的利用多层螺旋CT(multi-slice spiral CT,MSCT)对峡部裂性与退变性腰椎滑脱解剖学因素进行对比分析。方法选取108例腰椎滑脱患者,滑脱椎体均为L4,其中峡部裂性腰椎滑脱(峡部裂组)54例,退变性腰椎滑脱(退变组)54例,均经MSCT检查确诊。分别测量2组病例的骶骨倾斜角、腰椎前凸角、椎间关节角度、椎弓峡部宽度、滑脱距离、滑脱指数。结果峡部裂组年龄、腰椎前凸角、椎弓峡部宽度小于退变组,关节突关节面与矢状面夹角、滑脱指数大于退变组(P<0.05或P<0.01);2组骶骨倾斜角差异无统计学意义(P>0.05)。结论峡部裂性腰椎滑脱患者发病年龄早于、滑脱指数大于退变性腰椎滑脱患者;椎弓峡部发育不良或形态改变(纤细)为峡部裂性腰椎滑脱发病的重要因素;椎间关节面与矢状面夹角变小以及腰椎前凸角增大在退变性腰椎滑脱形成中起一定作用。

Objective To compare the anatomical factors for isthmic spondylolisthesis and de-generative spondylolisthesis using multi-slice spiral CT（MSCT）.Methods A total of 108 patients with L4 lumbar spondylolisthesis were divided into two groups：isthmic spondylolisthesis group and degenerative spondylolisthesis group,with 54 patients in each group.All be confirmed by MSCT examination.The sacral inclination angle,lumbar lordosis angle,intervertebral joint angle, vertebral arch isthmus width,slippage distance and slippage index were measured in both groups. Results Compared with degenerative spondylolisthesis group,the age,lumbar lordosis angle and vertebral arch isthmus width decreased and the facet and sagittal angles and slippage index in-creased in isthmic spondylolisthesis group（P 0.05）.Conclusion Isthmic spon-dylolisthesis is associated with an earlier age of onset and a higher slippage index than degenera-tive spondylolisthesis.Isthmus hypoplasia or changes in morphology （slender）are important fac-tors for the pathogenesis of isthmic spondylolisthesis.The decrease in intervertebral joint facet and sagittal angles and the increase in lumbar lordosis angle are involved in the degenerative spon-dylolisthesis.