青少年L5S1发育性滑脱与峡部裂性滑脱的脊柱骨盆矢状面形态比较

目的:比较青少年L_5S_1发育不良性滑脱与峡部裂性滑脱的脊柱骨盆矢状面形态特点。方法:对2002年5月至2016年12月收治的24例影像资料完整的青少年L_5S_1滑脱患者的病例资料进行回顾性分析。男8例,女16例,年龄10～18(13.4±2.0)岁;其中发育不良性滑脱(发育不良组)9例,峡部裂性滑脱(峡部裂组)15例。在站立位脊柱侧位片上测量滑脱相关指标(滑移距离、滑脱率、滑脱角)和脊柱骨盆矢状面形态指标(矢状面偏移、胸椎后凸角、腰椎前凸角、L_5入射角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、骨盆矢状面厚度、腰骶角、骶骨平台角)。对两组影像学参数进行统计学分析。结果:两组患者的滑脱距离、滑脱率和滑脱角差异无统计学意义。发育性滑脱组矢状面偏移、L_5入射角、骨盆倾斜角和骨盆矢状面厚度均明显高于峡部裂性滑脱组(P0.05)。发育性滑脱组的骶骨倾斜角、腰骶角和骶骨平台角则显著低于峡部裂性滑脱组(P0.05)。两组间胸椎后凸角和腰椎前凸角差异无统计学意义(P0.05)。结论:与峡部裂性滑脱明显不同,发育不良性滑脱表现为躯干前倾明显,骨盆后倾。对于发育不良性滑脱,需要严密观察,出现矢状面失平衡时则应早期手术干预。

Comparison of sagittal plane morphology of spine and pelvis in adolescents with L5S1 developmental spondylolisthesis and isthmic spondylolisthesis

Objective:To compare the sagittal morphological features of the spine and pelvis between L₅S₁ dysplastic spondylolisthesis and isthmus spondylolisthesis in adolescent.MethodsRetrospective analysis of 24 cases of adolescent L₅S₁ spondylolisthesis with complete imaging data from May 2002 to December 2016. Those included 8 males and 16 females,aged from 10 to 18 years old with an average of (13.4±2.0) years. Among them,9 cases were diagnosed as dysplastic spondylolisthesis (dysplasia group) and 15 cases isthmic spondylolisthesis (ischemic group). Radiographic parameters including slippage distance,slippage degree,slippage angle,sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),L₅ incidence(L₅I),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal pelvic thickness(SPT),lumbosacral angle (LSA),sacral table angle (STA) were measured on the spinal lateral X-ray of the standing position. Independent-samples t-test was used in the comparison of each variable between two groups. P<0.05 was considered statistically significant.ResultsThere were no significant differences in slippage distance,slippage rate,slippage angle between two groups. In dysplasia group,SVA,L₅I,PT,SPT were (37.0±48.4) mm,(57.0±14.8)°,(42.3±15.4)°,(56.1±21.2) mm,respectively,and (-11.0±22.2) mm,(31.7±19.3) °,(15.5±10.2)°,(31.4±19.1) mm in ischemic group;and the differences between the two groups were significant(P<0.05). In ischemic group,SS,LSA,STA were (44.1±12.6)°,(103.9±21.7)°,(92.7±9.9)°,respectively,and (25.9±20.2) °,(75.4±16.4) °,(75.4±9.7) ° in dysplasia group;and the differences between the two groups were significant(P<0.05). There was no significant difference in TK,LL between two groups(P>0.05).ConclusionSignificant different from isthmic spondylolisthesis,adolescents with dysplastic spondylolisthesis present a different spino-pelvic sagittal alignment,characterized with trunk forward leaning and pelvic retroversion. In case of sagittal imbalance,early surgical intervention is required to restore a balanced spino-pelvic alignment.