腰椎峡部裂与L_(5)椎弓根形态学变化的关系研究

Relationship of lumbar spondylolysis with L,pedicle morphological changes

目的:探讨腰椎峡部裂发生发展过程中L_(5)椎弓根的形态学变化,并进一步分析L 5椎弓根形态特征对峡部裂发生风险的影响。 方法:采用病例对照研究分析2022年7月至2023年6月中国人民解放军联勤保障部队第九六〇医院收治的144例腰椎峡部裂患者的影像学资料,其中男124例,女20例;年龄18~70岁[(35.7±14.4)岁]。腰椎双侧峡部裂患者79例(峡部裂组),峡部裂性腰椎滑脱患者65例(滑脱组)。选取同期144例腰椎CT平扫未见明显结构异常的志愿者作为对照组。运用影像归档和通信系统(PACS)于CT图像上测量L_(5)椎弓根的形态学参数,包括椎弓根长度(PL)、椎弓根螺钉轨迹长度(PSTL)、椎弓根宽度(PW)、椎弓根内倾角(PCA)、椎弓根高度(PH)和椎弓根峡部角(PIA)。先比较三组内左右侧别间各测量参数的差异,再将各组内左右侧的数据合并,比较三组间各测量参数的差异。为进一步探究L 5椎弓根形态特征对峡部裂发生风险的影响,将峡部裂组和对照组之间差异有统计学意义的测量参数纳入二元Logistic回归分析,筛选L 5椎弓根形态特征相关的峡部裂危险因素。 结果:三组内左右侧别间PL、PSTL、PW、PCA、PH和PIA差异均无统计学意义( P>0.05),各测量参数不受左右侧别因素的影响。峡部裂组PL、PSTL、PW、PCA和PIA分别为(13.5±2.0)mm、(47.6±2.4)mm、(15.5±2.0)mm、(29.0±2.9)°和(118.6±5.9)°,与滑脱组的(13.6±2.0)mm、(47.7±3.2)mm、(15.9±2.7)mm、(28.3±3.1)°和(119.2±5.8)°差异均无统计学意义( P>0.05),但均大于对照组的(12.8±1.7)mm、(45.1±3.1)mm、(14.9±2.0)mm、(25.6±3.0)°和(106.6±5.5)°( P<0.05);峡部裂组PH为(10.5±1.2)mm,与对照组的(10.8±1.3)mm差异无统计学意义( P>0.05),但均大于滑脱组的(10.0±1.3)mm( P<0.05)。二元Logistic回归分析结果显示,PCA增大( OR=1.40,95% CI 1.17,1.67, P<0.01)和PIA增大( OR=1.46,95% CI 1.30,1.64, P<0.01)与腰椎峡部裂显著相关。 结论:腰椎峡部裂患者L_(5)椎弓根相较于正常人群PL和PSTL更长、PW更宽、PCA和PIA更大,故具有“长、宽、外展”的形态学特征。L_(5)椎弓根形态学变化主要发生在峡部断裂前,且PCA和PIA增大是腰椎峡部裂的危险因素。

Objective To investigate the L,pedicle morphological changes during the development and progression of lumbar spondylolysis and further analyze the effects of Ls pedicle morphological characteristics on the risk of lumbar spondylolysis.Methods A case-control study was conducted to analyze the image data of 144 patients with lumbar spondylolysis who were admitted to 960th Hospital of Joint Logistic Support Force of PLA from July 2022 to June 2023,including 124 males and 20 females,aged 18-70 years[(35.7±14.4)years].Of them,79 patients had bilateral spondylolysis(spondylolysis group)and 65 patients had isthmic spondylolisthesis(spondylolisthesis group).At the same time,144 volunteers with no obvious structural abnormalities in a lumbar CT scan were selected as the control group.Picture archiving and communication system(PACS)was used to measure the morphological parameters of Ls pedicle on CT images,including pedicle length(PL),pedicle screw trajectory length(PSTL),pedicle width(PW),pedicle camber angle(PCA),pedicle height(PH),and pedicle isthmus angle(PIA).The differences of each parameter between the left and right sides in the three groups were compared first,and then the data of the left and right sides were merged to compare the differences of each parameter among the three groups.In order to further explore the effects of L,pedicle morphological characteristics on the risk of lumbar spondylolysis,the measurement parameters with statistically significant differences between the spondylolysis group and the control group were included in the binary Logistic regression analysis to screen the risk factors of lumbar spondylolysis related to L,pedicle morphological characteristics.Results There were no significant differences in the values of PL,PSTL,PW,PCA,PH or PIA between the left and right sides in the three groups(P>0.05),indicating those parameters were not affected by the left and right side factors.The values of PL,PSTL,PW,PCA and PIA in the spondylolysis group were(13.5±2.0)mm,(47.6±2.4)mm,(15.5±2.0)mm,(29.0±2.9)°,and(118.6±5.9)respectively,which were not significantly different from those in the spondylolisthesis group[(13.6±2.0)mm,(47.7±3.2)mm,(15.9±2.7)mm,(28.3±3.1),and(119.2±5.8)°respectively](P>0.05),but the values of the parameters of the above two groups were larger than those of the control group[(12.8±1.7)mm,(45.1±3.1)mm,(14.9±2.0)mm,(25.6±3.0)°,and(106.6±5.5)°](P<0.05).There was no significant dfference in the value of PH between the spondylolysis group[(10.5±1.2)mm]and the control group[(10.8±1.3)mm](P>0.05),but the values of PH of the above two groups were higher than that in the spondylolisthesis group[(10.0±1.3)mm](P<0.05).The results of binary Logistic regression analysis showed that the increased PCA(0R=1.40,95%CI 1.17,1.67,P<0.01)and increased PIA(OR=1.46,95%CI 1.30,1.64,P<0.01)were significantly correlated with lumbar spondylolysis.Conclusions The Ls pedicle in patients with lumbar spondylolysis has longer PL and PSTL,wider PW,and larger PCA and PIA than the normal population,showing the morphological characteristics of being"long,wide and extended".The morphological changes of the Ls pedicle mainly occur before the fracture of the lumbar isthmus,with increased PCA and PIA being the risk factors for lumbar spondylolysis.