脊柱骨盆矢状位参数预测退变性腰椎滑脱发生及发展的危险因素

Prediction of risk factors of occurrence and development of degenerative lumbar spondylolisthesis with sagittal parameters of the spine and pelvis

目的探讨脊柱骨盆矢状位参数预测退变性腰椎滑脱发生及发展的危险因素。方法退变性腰椎滑脱及退变性腰椎管狭窄症病人71例,其中退变性腰椎滑脱病人36例,退变性腰椎管狭窄症病人35例。在站立位全脊柱侧位片上测量骨盆投射角(PI)、骶骨倾斜角(SS)、骨盆倾斜度(PT)、腰椎前凸角(LL)、胸椎后凸角(TK)、腰椎骨盆前凸角(PR-LI,PR-L2,PR-L3,PR-L4,PR-L5)、骨盆形态(PR-S1)、腰4椎体倾斜角(L4S)、腰5椎体倾斜角(L5S)。所测退变性腰椎滑脱病例脊柱骨盆参数分别与退变性腰椎管狭窄症及正常国人脊柱骨盆参数进行比较,采用两独立样本t检验比较两组参数间的差异。结果退变性腰椎滑脱组PI[(57.67±11.78)°]、SS[(37.83±9.17)°]、LL[(54.65±11.45)°]明显大于退变性腰椎管狭窄症组[(44.47±8.75)°,(28.18±9.02)°,(38.97±15.59)°]及正常参考值[(44.75±9.01)°,(33.57±7.64)°,(48.75±10.03)°](P<0.05);退变性腰椎滑脱组L4S[(8.18±9.98)°]、L5S[(19.96±8.33)°]明显大于退变性腰椎管狭窄症组[(3.32±7.95)°,(10.87±8.02)°](P<0.05);退变性腰椎滑脱PR-L4[(57.63±13.44)°]、PR-L5[(45.76±10.92)°]及PR-S1[(27.91±10.41)°]明显小于退变性腰椎管狭窄症组[(65.48±10.70)°,(56.33±9.15)°,(38.63±7.29)°](P<0.05)。结论高PI可能引起退变性腰椎滑脱发生及发展,L5椎体倾斜角是退变性腰椎滑脱发生的预测因素之一,退变性腰椎滑脱下腰椎骨盆前凸明显小于退变性腰椎管狭窄症。

Objective To explore the risk factors related to the development and progression of lumbar degenerative spondylolisthesis(LDS).Methods A total of 71 patients with LDS or degenerative spinal stenosis(DSS)were retrospectively.Thirty-six patients with LDS(group LDS)and 35 patients with DSS(group DSS)were enrolled.Spinopelvic parameters including pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),thoracic kyphosis(TK),regional lumbopelvic lordosis angles(PR-LI,PR-L2,PR-L3,PR-L4,PR-L5),pelvic morphology(PR-S1),lumbar 4 slope(L4 S)and lumbar 5 slope(L5 S)were assessed on whole spine lateral radiographs in a standing position.All the parameters from LDS will compared with those of DSS and normal population respectively,Student’s t-test was used to compare each parameter among the LDS,DSS and normal population.Results PI[(57.67±11.78)°],SS[(37.83±9.17)°]and LL[(54.65±11.45)°]in group LDS were significantly greater than those of group DSS[(44.47±8.75)°,(28.18±9.02)°,(38.97±15.59)°]and normal reference value[(44.75±9.01)°,(33.57±7.64)°,(48.75±10.03)°](P<0.05).L4 S[(8.18±9.98)°]and L5 S[(19.96±8.33)°]in group LDS were greater than the group DSS[(3.32±7.95)°,(10.87±8.02)°](P<0.05).The PR-L4[(57.63±13.44)°],PR-L5[(45.76±10.92)°]and PR-S1[(27.91±10.41)°]in group LDS were significantly smaller than those of group DSS[(65.48±10.70)°,(56.33±9.15)°,(38.63±7.29)°](P<0.05).Conclusion Greater PI may lead to the development and progression of lumbar degenerative spondylolisthesis.L5 S is a parameter that can be used to predict the risk of LDS.The lower regional lumbopelvic lordosis angles in LDS were smaller than those of DSS.