重度发育不良性腰椎滑脱的影像学特点及其临床意义

目的 对重度发育不良性腰椎滑脱的临床及影像学特点进行初步探讨.方法 回顾性分析2007年3月至2008年12月收治的6例重度发育不良性腰椎滑脱患者(滑脱组,均为女性,年龄为9～12岁)的临床资料,并与因腰痛而就诊的44例儿童(对照组,男性27例,女性17例,年龄9～12岁,影像学检查未见骨折与脱位)进行对比分析,在X线片上测量两组患者骨盆投照角(PI),腰椎前凸角(LL),骶骨后凸角(SK)等指标,比较两组测量值的差异并探讨其临床意义.结果 重度发育不良性腰椎滑脱患者的临床特征是膝关节屈曲、躯干畸形,坐骨神经疼痛;其影像学特征是腰骶关节后凸畸形、骨盆后倾以及拱顶型骶骨;影像学测量方面,滑脱组的LL、PI测量值为(51±10)°、(52±7)°,分别大于对照组的(18±9)°、(43±8)°,差异有统计学意义(P<0.05);滑脱组SK测量值为(12±11)°,小于对照组的(21±10)°,差异有统计学意义(P<0.05).结论 重度发育不良性腰椎滑脱患者外观症状重、神经系统症状轻,腰骶关节连续性中断;PI、LL、SK是其较有意义的影像学测量参数.

Characteristics of clinical findings and radiological assessment of high grade developmental spondylolisthesis

Objectives To investigate clinical appearance and radiological characteristics of high grade developmental spondylolisthesis and their significance. Methods In a retrospective study, a group of 6 female patients, who were diagnosed as high grade developmental spondylolisthesis and treated in Peking University third hospital from March 2007 to December 2008 were included. Clinical and radiological characteristics of the 6 patients were investigated and the following parameters were measured on standing lateral X-ray: PI (pelvic incidence), SK (sacral kyphosis) and LL (Lumbar lordosis). A series of 44 patients who came to out-patient department due to LBP and had no positive findings on lateral lumbar X-ray were selected as the control group. The four parameters were compared between study group and control group. Clinical meanings of significant difference were discussed. Results Clinical findings of high grade developmental spondylolisthesis included bending of knees, deformity of trunk and sciatica. Radiological appearances were characterized with kyphosis of lumbo-sacral joint, retroverted pelvis and domed sacrum.Spondylolisthesis patients has an average PI of (52 ± 7) ° which was significant higher than the control group (43 ±8) °] (P <0. 01 ). LL of study group (51 ± 10) °] was higher than that of the control group (18± 9) °] (P < 0. 01) and SK of the study group (12 ±11)°] were lower than that of the control group (21 ± 10)°] (P<0.05). Conclusions Characteristics of clinical findings of spondylolisthesis patients have obvious cosmetic appearance, significant pain and lower neurological deficits. Radiological characteristics display deformity of lumbo-sacral joint. PI, LL and SK are significant parameters for high grade spondylolisthesis.