腰椎滑脱亚型间影像学参数与生活质量评分的对照分析

A comparative study of imaging parameters and quality of life scores between subtypes of lumbar spondylolisthesis

背景:既往研究报道了对腰椎滑脱患者与正常人群的脊柱骨盆矢状位参数比较,而对于不同亚型腰椎滑脱患者之间的影像学参数差异及其对生活质量评分影响的对比研究相对匮乏。目的:分析腰椎滑脱亚型间影像学参数差异与生活质量之间的关系。方法:回顾性分析腰椎滑脱的患者63例,分为退变性腰椎滑脱组35例和峡部裂性腰椎滑脱组28例,对比分析两组患者的脊柱骨盆影像学参数,包括脊柱矢状轴、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、骨盆入射角与腰椎前凸角匹配度、L1椎体铅垂线、上腰弯、下腰弯和功能评分(健康相关生活质量评分)差异。研究方案的实施符合《赫尔辛基宣言》和天津市人民医院对研究的相关伦理要求,患者对测试项目完全知情同意。结果与结论:(1)手术前影像学参数的对比,退变性腰椎滑脱组脊柱矢状轴显著高于峡部裂性腰椎滑脱组;退变性腰椎滑脱组骨盆倾斜角、腰椎前凸角、上腰弯和下腰弯均显著低于峡部裂性腰椎滑脱组(均P<0.05或P<0.01);其余影像学指标在两组之间未见显著差异性;(2)两组术前腰背痛目测类比评分≤3分患者骨盆倾斜角明显低于腰背痛目测类比评分>3分患者(P=0.026,P=0.047);(3)两组术前ODI指数>40分患者与ODI指数≤40分患者的影像学指标无明显统计学差异;(4)结果说明,退变性腰椎滑脱与峡部裂性腰椎滑脱矢状位生物力学方面存在显著差异;腰椎滑脱患者腰背痛目测类比评分≤3分的患者骨盆倾斜角明显低于目测类比评分>3分的患者。

BACKGROUND:Previous studies have reported the comparison of the sagittal parameters of the spine and pelvis between patients with lumbar spondylolisthesis and the normal population,but comparative studies on the differences in imaging parameters between patients with different subtypes of lumbar spondylolisthesis and their impact on the quality of life scores are relatively scarce.OBJECTIVE:To analyze the differences in imaging parameters between subtypes of lumbar spondylolisthesis and its relationship with quality of life.METHODS:This study retrospectively analyzed 63 patients with lumbar spondylolisthesis.These patients were divided into degenerative lumbar spondylolisthesis group(n=35)and isthmic spondylolisthesis group(n=28).Spine and pelvic imaging parameters,including sagittal vertebral axis,lumbar lordosis,pelvic incidence,pelvic tilt,sacral slope,pelvic incidence-lumbar lordosis matching,lumbar 1 plumb line,upper lumbar curve,and lower lumbar curve,and functional score(health related quality of life score)were analyzed between the two groups.The protocols were in accordance with the relevant ethical requirements of Declaration of Helsinki and Tianjin People’s Hospital.The patients signed informed consent.RESULTS AND CONCLUSION:(1)In the study of preoperative imaging parameters,sagittal vertebral axis was significantly higher in the degenerative lumbar spondylolisthesis group than that in the isthmic spondylolisthesis group.Pelvic tilt,lumbar lordosis,upper lumbar curve,and lower lumbar curve were significantly lower in the degenerative lumbar spondylolisthesis group than those in the isthmic spondylolisthesis group(all P<0.05 or P<0.01).The other imaging indications showed no significant differences between the two groups.(2)Pelvic tilt was significantly lower in patients with visual analogue scale(low back pain)score≤3 than that in patients scoring>3(P=0.026,P=0.047).(3)There was no significant difference in imaging indexes between the two groups of patients with preoperative Oswestry disability index>40 and those with Oswestry disability index≤40.(4)The results have shown that there are significant differences in sagittal biomechanics between degenerative lumbar spondylolisthesis and isthmic fissure lumbar spondylolisthesis.Pelvic tilt was significantly lower in patients with visual analogue scale(low back pain)score≤3 than that in patients scoring>3.