脊柱-骨盆矢状面参数与L5峡部裂性滑脱进展的相互作用

Interaction effect of spino-pelvic parameters and progress of L_5 isthmic spondylolisthesis

背景:目前从脊柱-骨盆矢状面角参数度解释滑脱进展日益受到重视,但缺乏统一观点,且两者的相互作用尚无归纳总结。目的:分析L5峡部裂性滑脱中脊柱-骨盆矢状面参数、L5/S1椎间盘退变程度与滑脱率之间的相关性,探讨脊柱-骨盆参数与滑脱进展的相互作用。方法:选择2013年9月至2017年9月就诊且资料完整的83例L5峡部裂性滑脱患者,年龄21-79岁,体质量43-91 kg,其中男30例,女53例。在侧位脊柱X射线片上测量患者腰椎前凸角、骨盆入射角和滑脱率,在矢状面腰椎MRI上利用改良Pfirrmann分级标准评估L5/S1椎间盘退变程度;分别按照骨盆入射角值大小、L5/S1椎间盘评分及滑脱率进行分组。结果与结论:(1)按骨盆入射角大小分组,>60°组L5/S1椎间盘退变程度显著大于45°-60°组(正常组)和<45°组,45°-60°组(正常组)显著大于<45°组;骨盆入射角>60°组腰椎前凸角显著大于45°-60°组(正常组)和<45°组,45°-60°组(正常组)显著大于<45°组;骨盆入射角>60°组滑脱率显著大于<45°组;(2)按椎间盘退变程度分组,高重度退变组滑脱率显著大于低重度退变组和轻中度退变组,低重度退变组显著大于轻中度退变组;高重度退变组腰椎前凸角显著大于低重度退变组和轻中度退变组,后两者差异无显著性意义;(3)对于腰椎前凸角,滑脱率为25%-50%的患者与滑脱率<25%的患者之间差异无显著性意义;(4)提示脊柱-骨盆矢状面参数与L5峡部裂性滑脱进展可能存在相互作用,骨盆入射角与腰椎形态、L5/S1椎间盘退变程度及滑脱进展紧密相关,而L5/S1椎间盘退变程度可能影响腰椎形态和L5滑脱进展。轻中度滑脱可能不会引起腰椎前凸角的改变。临床上应更加重视骨盆入射角较大的L5/S1峡部裂性滑脱患者。

BACKGROUND： Progress of L5 isthmic spondylolisthesis determined based on the spino-pelvic sagittal parameters has been drawn much attention, but has not been confirmed. Their interactions have not been summarized. OBJECTIVE： To investigate the correlations of spino-pelvic parameters and degeneration of L5/S1 intervertebral disc with spondylolisthesis rate in L5 isthmic spondylolisthesis, and to explore the interaction between spino-pelvic parameters and progress of spondylolisthesis. METHODS： Eighty-three patients with L5 isthmic spondylolisthesis from September 2013 to September 2017 were included. All the patients aged from 21 to 79 years, body mass was from 43 to 91 kg, including 30 males and 53 females. The lumbar lordosis （LL）, pelvic incidence （PI） and spondylolisthesis rate were measured on the lateral lumbar X-ray, and the patients were then assigned based on these indexes. L5/S1 intervertebral disc degeneration was measured on lumbar sagittal MRI using the modified Pfirrmann grading system. RESULTS AND CONCLUSION： （1） Grouped by PI, the degeneration of disc and LL were the severest in the PI 〉 60° group, followed by normal （PI： 45° -60°） group, and the lowest in the PI 〈 45° group. The spondylolisthesis rate in the PI 〉 60° group was significantly higher than that in the PI 〈 45° group. （2） Grouped by degeneration of disc, highly severe group had significantly greater spondylolisthesis rate than that in the low severe group and mild-moderate groups, and the low severe group had significantly greater spondylolisthesis rate than that in the mild-moderate group. LL in the highly severe group was significantly greater than that in the low severe and mild-moderate groups, and there was no significant difference between low severe and mild-moderate groups. （3） As for LL, there was no significant difference between group with 〈 25% spondylolisthesis rate and group with 25%-50% spondylolisthesis rate. （4） Spino-pelvic parameters interact with progress of L5 isthmic spondylolisthesis. PI is closely related to lumbar morphology, degeneration of L5/S1 disc and progress of spondylolisthesis. Degeneration of L5/S1 disc probably affects lumbar morphology and progress of spondylolisthesis. Mild and moderate spondylolisthesis cannot change the LL probably. Clinically surgeons should pay more attention on patients with great PI.