退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析

目的:分析退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)中腰椎-骨盆结构特点及其在退变性腰椎滑脱症中的意义。方法:对2015年4月至2017年1月收治的45例单纯退行性L_(4,5)节段腰椎滑脱患者(滑脱组)的临床资料进行回顾性分析,并与同期50例(对照组)体检资料齐全的健康者进行比较。通过影像学资料对受试者的腰椎-骨盆结构参数进行统计分析,分析DLS患者的脊柱-骨盆特点。观察退变性腰椎滑脱患者椎间盘及关节突关节退变特点。利用Spearson分析各观察项目之间的相关性。结果:滑脱组L_(4,5)关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(36.5±11.2)°、(44.2±7.3)°、(66.5±11.6)°、(22.2±10.0)°、(33.4±11.3)°。对照组L_(4,5)关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(44.4±8.2)°、(36.7±8.5)°、(55.4±13.2)°、(14.4±7.0)°、(42.3±13.1)°,滑脱组骨盆入射角、腰椎前凸角、骨盆倾斜角明显大于对照组(P0.05),而关节突关节角、骶骨倾斜角小于对照组(P0.05)。两组骨盆入射角与骨盆倾斜角、骶骨倾斜角之间有相关性(P0.05),椎间盘退变与关节突关节之间存在相关性(P0.05)。滑脱组L3-S1椎间盘及L_(4,5)关节突关节退变更加严重。结论:腰椎-骨盆结构在退变性腰椎滑脱中发生了明显的变化。腰椎前凸及骨盆后倾现象在腰椎退变性滑脱身体代偿机制中有重要作用,腰椎关节突关节退变与腰椎间盘退变是相互促进的,腰椎滑脱加剧椎间盘与关节突关节退变。

Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis

Objective: To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis (DLS).Methods: The clinical data of 45 patients with simple degenerative L_4,5-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed,which were compared with 50 healthy people with complete physical examination data in the same period (control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through imaging data was performed to analyze the characteristics of the spine-pelvis of DLS patients. The degenerative characteristics of intervertebral disc and articular process joint were observed in degenerative lumbar spondylolisthesis. Use Spearson to analyze the correlation between observation items.Results: The facet joint angle,lumbar lordosis angle (LL),pelvic incidence angle (PI),pelvic tilt angle (PT),sacral slope angle (SS) in spondylolisthesis group of L_4,5-segment were (36.5±11.2)°, (44.2±7.3)°, (66.5±11.6)°, (22.2±10.0)°, (33.4±11.3)°,respectively,while in control group were (44.4±8.2)°, (36.7±8.5)°, (55.4±13.2)°, (14.4±7.0)°, (42.3±13.1)°. PI,LL,PT of spondylolisthesis group were obviously larger than that of control group (P<0.05),the facet joint angle and SS of spondylolisthesis group were smaller than that of control group (P<0.05). The correlation analysis showed that PI value was related to the PT and SS in two group. The degree of degeneration of intervertebral disc was related to the degree of spondylolisthesis. The degree of degeneration of L₃-S₁ intervertebral disc and L_4,5 facet joint in spondylolisthesis group was more serious (P<0.05).Conclusion: Lumbar spinal-pelvic structure of degenerative lumbar spondylolisthesis has undergone significant changes. Lumbar lordosis and pelvic dumping phenomenon in the mechanism of lumbar degeneration plays an important role. Lumbar facet joint degeneration and lumbar intervertebral disc degeneration are mutually promoted,and lumbar spondylolisthesis aggravates intervertebral disc and facet joint degeneration.