腰椎骶化对峡部裂性腰椎滑脱影响的影像分析

An image analysis on impact of lumbar sacralization on lumbar isthmic spondylolisthesis

[目的]探讨腰椎骶化对峡部裂性腰椎滑脱的影响。[方法]回顾性分析2007年1月~2018年7月就诊的125例L4峡部裂患者,其中59例伴有腰椎骶化。根据Castellvi分型将腰椎骶化者分为Castellvi Ⅱ型组及Castellvi Ⅲ型组。分别比较腰椎骶化组与无腰椎骶化组、Castellvi Ⅱ型组与Castellvi Ⅲ型组的滑脱率、椎间盘及终板的退变程度。[结果]腰椎骶化组与无腰椎骶化组在性别及年龄方面比较差异均无统计学意义(P>0.05)。腰椎骶化组的滑脱率为(33.32±14.42)%,明显高于无腰椎骶化组的(23.76±10.25)%(P<0.05)。腰椎骶化组椎间盘改良Pfirrmann分级明显高于无腰椎骶化组(P=0.002)。Castellvi Ⅱ型组23例,Castellvi Ⅲ型组36例,两组性别及年龄比较差异均无统计学意义(P>0.05);Castellvi Ⅱ型组的滑脱率为(28.42±14.28)%,明显低于Castellvi Ⅲ型组的(36.46±13.80)%(P=0.035)。两组椎间盘及终板的退变程度比较差异均无统计学意义(P>0.05)。[结论]腰椎骶化加剧了L4峡部裂性滑脱及椎间盘退变,且骨性融合越明显,相应的滑脱程度越严重。

[Objective] To explore the impact of lumbar sacralization on lumbar isthmic spondylolisthesis. [Methods] A retrospective study was conducted on 125 patients who had L4 isthmic spondylolisthesis diagnosed from January 2007 to July 2018 in our hospital. Of them, 59 patients were accompanied by lumbar sacralization. According to Castellvi classification, patients with lumbar sacralization were divided into Castellvi type Ⅱ sub-group and Castellvi type Ⅲ sub-group. The ratio of spondylolisthesis and the degree of intervertebral disc degeneration and extent of endplate change were compared between the lumbar sacralization group and the non-lumbar sacralization group, as well as between the Castellvi type Ⅱ sub-group and the Castellvi type Ⅲ sub-group. [Results] There was no significant difference in gender and age between the lumbar sacralization group and the non-lumbar sacralization group(P>0.05). The ratio of spondylolisthesis was(33.32 ± 14.42)% in the lumbar sacralization group, whereas(23.76 ± 10.25)% in the non-lumbar sacralization group, which proved statistically significant(P<0.05). The modified Pfirrmann grade of intervertebral discs was also significantly higher in the lumbar sacralization group than that in the non-lumbar sacralization group(P=0.002). In addition, 23 patients fall in the Castellvi type Ⅱ sub-group and 36 cases were in the Castellvi type Ⅲ sub-group. There was no significant difference in gender and age between the two groups(P>0.05). The ratio of slippage was(28.42±14.28)% in the Castellvi type Ⅱ sub-group, whereas(36.46±13.80)% in the Castellvi type Ⅲ subgroup, which was statistically significant(P=0.035). However, there was no statistical difference in the degree of degeneration of the intervertebral disc and endplate between the two groups(P>0.05). [Conclusion] Lumbar sacralization does aggravate lumbar isthmic spondylolisthesis and intervertebral disc degeneration, and the more obvious the bony union, the more severe the corresponding spondylolisthesis is.