双节段退行性腰椎滑脱症脊柱-骨盆矢状面参数特征

Characteristics of sagittal spinopelvic parameters in double-level lumbar degenerative spondylolisthesis

目的评估双节段退行性腰椎滑脱(dLDS)患者脊柱-骨盆矢状面失衡情况并探讨其代偿机制,为临床dLDS的诊治提供理论基础。方法回顾性分析2015年1月—2020年12月收治的80例Meyerding分级Ⅰ~Ⅱ级的退行性腰椎滑脱(LDS)患者资料,根据滑脱节段分为dLDS组(20例)和单节段LDS(sLDS)组(60例),另选取40例无症状志愿者作为对照组。在术前站立位全脊柱侧位X线片上测量各组的脊柱-骨盆矢状面参数,包括骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、颈椎前凸角(CL)、胸椎后凸角(TK)、腰椎前凸角(LL)、下腰椎前凸角(LLL)、L_(5)入射角(L_(5)I)、矢状面偏移(SVA),并计算前凸分布指数(LDI)和PI-LL值(PI与LL的差值)。采用Oswestry功能障碍指数(ODI)和疼痛视觉模拟量表(VAS)评分对患者日常生活质量进行评估。结果dLDS组和sLDS的PI、PT、L_(5)I、SVA、PI-LL均大于对照组,且dLDS组大于sLDS组,差异均有统计学意义(P<0.05);dLDS组和sLDS的LLL、LDI均小于对照组,且dLDS组小于sLDS组,差异均有统计学意义(P<0.05)。dLDS组的SVA、PI-LL、PT失衡发生率均高于sLDS组,差异有统计学意义(P<0.05)。LDS患者均有不同程度腰腿痛,且dLDS组的ODI、下腰痛和腿痛VAS评分均高于sLDS组,差异均有统计学意义(P<0.05)。相关分析结果显示,dLDS组ODI、下腰痛和腿痛VAS评分与PT、SVA、PI-LL呈正相关,与LL、LLL呈负相关。结论与sLDS患者相比,dLDS患者脊柱-骨盆矢状面参数改变更显著,矢状面失衡更严重,高PI值和L_(5)I值可能是dLDS发生发展的重要危险因素。

Objective To evaluate the sagittal spinopelvic parameters in patients with double-level lumbar degenerative spondylolisthesis(dLDS)and explore its compensatory mechanisms,so as to provide relevant theoretical basis for the diagnosis and treatment of dLDS.Methods From January 2015 to December 2020,the data of 80 patients with low-grade(Meyerding gradeⅠ-Ⅱ)LDS were retrospectively analyzed.According to the number of spondylolisthesis segments,they were divided into dLDS group(20 cases)and single-level LDS(sLDS)group(60 cases),and 40 asymptomatic volunteers were included in the study as the control group.Sagittal spinopelvic parameters including pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),cervical lordosis(CL),thoracic kyphosis(TK),lumbar lordosis(LL),L_(4)-S_(1) lumbar lordosis(LLL),L_(5) incidence(L_(5)I)and sagittal vertical axis(SVA)were assessed on preoperative whole spine standing lateral roentgenograph,and values of lordosis distribution index(LDI)and PI-LL were calculated.The quality of life was evaluated by Oswestry disability index(ODI)and visual analog scale(VAS)score,respectively.Results PI,PT,L_(5)I,SVA and PI-LL in dLDS and sLDS groups were significantly higher than those in the control group,and those in dLDS group were significantly higher than those in sLDS group,all with a statistical significance(P<0.05).However,the LLL and LDI of dLDS and sLDS groups were significantly lower than those in the control group,and those in dLDS group were significantly lower than those in sLDS group,all with a statistical significance(P<0.05).The incidence of SVA,PI-LL and PT imbalance in dLDS group were significantly higher than those in sLDS group,and the differences were statistically significant(P<0.05).All the patients with LDS have different intensity of low back and leg pain,and the ODI and VAS scores of low back and leg pain in dLDS group were significantly higher than those in sLDS group,and the differences were statistically significant(P<0.05).The correlation analysis showed that ODI and VAS scores of low back and leg pain in dLDS patients were significantly positively correlated with PT,SVA and PI-LL,and negatively correlated with LL and LLL.Conclusions Compared with sLDS patients,the changes of sagittal spinopelvic parameters in dLDS patients are more significant,and the sagittal imbalance is more serious.High PI and L_(5)I values may be important risk factors for the development and progression of dLDS.