脊柱-骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响

Effect of spinopelvic sagittal parameters and facet joint angle on degenerative lumbar spondylolisthesis

目的:探讨脊柱-骨盆矢状位参数及关节突关节角度对退变性腰椎滑脱的影响及相关性研究。方法:以2016年7月至2019年9月确诊的120例L4-L5单节段退变性滑脱患者为观察对象(滑脱组),以性别和年龄相匹配的120例L4-L5节段退变性椎管狭窄患者为对照(对照组)。通过影像学资料测量如下参数:骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS),腰椎前凸(lumbar lordosis,LL),胸椎后凸(thoracic kyphosis,TK),矢状面平衡(sagittal vertical axis,SVA),L4-L5头侧关节突关节角,尾侧关节突关节角及小关节不对称性。比较两组患者参数的差异并对有意义参数行Logistic回归分析。对退变性腰椎滑脱患者关节突关节方向与脊柱-骨盆参数进行相关性分析。结果:两组患者在PI、PT、LL、SVA、头侧关节突关节角、尾侧关节突关节角差异有统计学意义(P<0.05);Logistic回归分析发现PI、PT及头侧关节突关节角是腰椎滑脱程度的危险因素(P<0.05)。滑脱组头侧关节突关节矢状化与PI、PT呈现显著相关(P<0.05)。结论:高PI、PT及头侧关节突关节矢状化是腰椎滑脱的危险因素,并且关节突关节矢状化程度和大PI、PT密切相关。

Objective:To investigate the effect and correlation of spinopelvic sagittal parameters and facet joint angle on degenerative lumbar spondylolisthesis.Methods:From July 2016 to September 2019,a total of 120 patients with L4-L5 single-segment degenerative spondylolisthesis were selected as observation objects(spondylolisthesis group),and 120 patients with L4-L5 single-segment degenerative spinal stenosis matched by gender and age were selected as the control group.The following parameters were measured by imaging data:pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),thoracic kyphosis(TK),sagittal vertical axis(SVA),L4-L5 cephalic facet joint angle,caudal facet joint angle and facet asymmetry.The differences of parameters between the two groups were compared and the meaningful parameters were analyzed by Logistic regression.The correlations between facet joint direction and spinopelvic parameters in patients with degenerative lumbar spondylolisthesis were analyzed.Results:There were significant differences in PI,PT,LL,SVA,cephalic facet angle and caudal facet angle between two groups(P<0.05).Logistic regression analysis showed that PI,PT and cephalic facet joint angle were the risk factors for lumbar spondylolisthesis(P<0.05).The sagittal of the cephalic facet joint in spondylolisthesis group was significantly correlated with PI and PT(P<0.05).Conclusion:High PI,PT and sagittal of cephalic facet joint are the risk factors for lumbar spondylolisthesis,and the sagittal degree of facet joints is closely related to high PI and PT.