退变性与峡部裂性腰椎滑脱症患者脊柱-骨盆复合体矢状面形态学及生活质量的比较

Comparison of sagittal spino-pelvic morphology and life quality between degenerative and isthmic lumbar spondylolisthesis patients

背景:峡部裂性滑脱与退变性滑脱的发病机制不尽相同,两者在脊柱-骨盆矢状面形态各参数及生活质量之间是否存在差异,目前尚不清楚。目的:探讨退变性滑脱症与成人腰椎峡部裂性滑脱症患者脊柱-骨盆矢状面形态及生活质量的差异。方法:回顾性分析2012年5月至2015年2月就诊且有完整影像学资料的退变性滑脱症与成人腰椎峡部裂性滑脱症患者共169例,其中退变性滑脱(退变组)83例,峡部裂性滑脱(峡部裂组)86例。在站立位全脊柱侧位片上测量两组患者脊柱-骨盆矢状面形态学指标,包括胸椎后凸角、腰椎前凸角、矢状面平衡、骨盆入射角、骨盆倾斜角、骶骨倾斜角。同时测量两组病例的腰椎滑脱角、滑脱率以及滑脱距离,运用SF-36量表评估患者的生活质量,并进行组间比较。结果与结论:1退变组患者腰椎前凸角、胸椎后凸角及滑脱角明显低于峡部裂组(P<0.05-0.01);退变组患者矢状面平衡明显高于峡部裂组(P<0.01);2就SF-36量表各维度而言,退变组身体功能维度得分、社会功能维度得分低于峡部裂组(P<0.01);3两组患者在骨盆入射角、骨盆倾斜角、骶骨倾斜角、滑脱率及滑脱距离方面差异均无显著性意义(P>0.05);4结果提示,退变性滑脱症与成人腰椎峡部裂性滑脱症患者具有相似的骨盆矢状面形态,但峡部裂性滑脱症患者较退变性滑脱症患者表现为更大的胸椎后凸、腰椎前凸以及滑脱角。此外,退变性滑脱症患者身体功能、社会功能维度受到明显的损害。

BACKGROUND：Due to different pathogenesis of degenerative and isthmic lumbar spondylolisthesis,the differences in sagittal spino-pelvic morphology and life quality between them are still unclear.OBJECTIVE：To investigate the differences in sagittal spino-pelvic morphology and life quality between degenerative and adult isthmic lumbar spondylolisis patients.METHODS：From May 2012 to February 2015,169 lumbar spondylolisthesis patients with complete imaging data were included in the study.Degenerative group contained 83 patients,and isthmic group contained 86 patients.The following radiographical parameters were measured on standard standing lateral radiographs of the entire spine,including thoracic kyphosis,lumbar lordosis,sagittal vertical axis,pelvic incidence,pelvic tilt and sacral slope.Meanwhile,slippage angle,slippage percentage and slippage distance of all patients were also measured.SF-36 scale was employed to evaluate life quality,which was compared between groups.RESULTS AND CONCLUSION：（1） Lumbar lordosis,thoracic kyphosis and slippage angle were significantly lower in the degenerative group than those in the isthmic group（P〈0.05-0.01）.The sagittal vertical axis in degenerative group was higher than that in isthmic group（P〈0.01）.（2） With respect to the domains of SF-36 scale,degenerative group had lower physical functioning score and social functioning score compared with the isthmic group（P〈0.01）.（3） Pelvic incidence,pelvic tilt,sacral slope,slippage percentage and slippage distance showed no significant difference between two groups（P〈0.05）.（4） Results suggested that pelvic morphology between the degenerative and isthmic lumbar spondylolisthesis was similar.Compared with degenerative lumbar spondylolisthesis,isthmic spondylolisthesis patients have higher thoracic kyphosis,lumbar lordosis and slippage angle.In addition,notable limitations of physical functioning and social functioning were found in degenerative lumbar spondylolisthesis patients.