退变性腰椎滑脱发病的相关因素探讨

Factors related to pathogenesis of degenerative lumbar spondylolisthesis

[目的]探讨退变性腰椎滑脱发生的相关因素。[方法] 2016年6月~2018年5月,198例腰腿疼痛患者纳入本研究。其中,退变滑脱组95例,无滑脱组103例。测量两组患者的BMI、骨盆入射角、骨盆倾斜体、骶骨倾斜角、腰骶角、腰椎前凸角;采用Kalichman关节突退变分级和Pfirrmann椎间盘退变分级评价退变程度。[结果]两组的体质量指数、骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰骶角、腰椎前凸角差异无统计学意义(P>0.05)。退变滑脱组的骨盆入射角明显大于无滑脱组,差异有统计学意义(P<0.05);退变滑脱组的L4/5节段关节突关节角明显大于无滑脱组,差异有统计学意义(P<0.05)。滑脱节段Kalichman关节突关节退变程度分级和Pfirrmann椎间盘退变分级均显著大于非滑脱节段(P<0.05);Kalichman分级和Pfirrmann分组呈显著正相关(P<0.05)。[结论]退变性腰椎滑脱的关节突关节和椎间盘退变程度重,骨盆入射角较大,L4/5关节突关节的方向更趋向矢状位。

[Objective] To explore the factors related to pathogenesis of degenerative lumbar spondylolisthesis(DLS). [Methods] From June 2016 to May 2018, a total of 198 patients who visited our hospital for low back pain and leg pain were enrolled in this study. Of them,95 patients were accompanied with DLS, while the remaining 103 patients were non-DLS. The parameters, including body mass index(BMI), as well as pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), lumbosacral angle(LA) and lumbar lordosis(LL) measured on Xray image, were compared between the two groups. In addition, the Kalichman grading for facet joint degeneration and Pfirrmann grading for intervertebral disc degeneration were used for evaluation. [Results] Although there was no significant differences between the DLS group and the non-DLS group in BMI, PT, SS, LA and LL(P>0.05), the DLS group has significantly greater PI than the non-DLS group(P<0.05). Additionally, the DLS group had significantly greater L4-5 lumbar facet joint angle than the non-DLS group(P<0.05). The slipped segments got significantly severer Kalichman grade and Pfirrmann grade than the non-slipped segments(P<0.05). There was a positive correlation between the Kalichman grade and Pfirrmann grade(P<0.05). [Conclusion] The degenerative lumbar spondylolisthesis has severer degeneration of facet joint and intervertebral disc of the involved segment, greater pelvic incidence, and a tendency of sagittal facet joint orientation.