L4～S1椎弓根形态与椎板间及椎间孔大小的相关性

目的 研究腰椎椎弓根形态（长度及角度）与L₄/L₅和L₅/S₁节段椎板间及椎间孔大小的相关性。方法 回顾性分析海军军医大学长征医院2020年1月—2022年6月收治的50例L₄/L₅或L₅/S₁单节段腰椎椎间盘突出症（LDH）患者作为研究组，并选取同时期50名健康志愿者作为对照组。测量2组腰椎正侧位X线片上L₄/L₅和L₅/S₁节段椎板间的最大高度和宽度，在CT上测量椎弓根长度和角度、椎间孔最小高度和宽度，采用逐步多元线性回归的多元相关性来确定相关变量对椎间孔及椎板间大小的独立影响。结果 2组L₄~S₁椎弓根长度、L₄/L₅及L₅/S₁节段椎间孔和椎板间高度差异无统计学意义（P>0.05）。研究组S₁椎弓根外展角小于对照组；研究组L₄椎弓根头倾角低于对照组，S₁椎弓根头倾角高于对照组；研究组L₄与L₅、L₅与S₁椎弓根头倾角差值低于对照组；研究组L₄/L₅和L₅/S₁节段椎间孔宽度、椎板间宽度小于对照组；以上指标差异均有统计学意义（P<0.05）。Pearson相关分析显示，年龄与椎板间高度和宽度及椎间孔高度呈负相关，椎弓根外展角与椎板间宽度呈正相关，椎弓根长度与椎间孔宽度呈正相关，相邻腰椎椎弓根头倾角差值与椎间孔宽度呈正相关，椎板间宽度与椎间孔宽度呈正相关。多重线性回归分析显示，患者的年龄、椎弓根长度及角度与椎板间及椎间孔大小独立相关，L₅、S₁椎弓根外展角与椎板间宽度显著正相关，L₅椎弓根头倾角与L₄/L₅及L₅/S₁椎间孔高度显著负相关；相邻腰椎椎弓根头倾角差值与椎间孔宽度显著正相关。结论 椎板间及椎间孔高度和宽度会随着患者年龄增长而变小，椎板间宽度随着L₅、S₁椎弓根外展角度增大而变大，L₅椎弓根头倾角越大，相邻椎间孔高度越小；相邻椎体椎弓根头倾角差值增加，椎间孔宽度增大。椎弓根角度和长度影响椎板间及椎间孔的大小，这些变化可能会影响手术难度和手术方式选择。

Correlation between pedicle morphology of L4-S1 and size of interlaminate and foramen

Objective To study the correlation between the lumbar pedicle shape(length and angle) and the size of intervertebral foramen in L₄/L₅ and L₅/S₁ segments. Methods From January 2020 to June 2022, 50 patients with L₄/L₅ or L₅/S₁ lumbar disc herniation(LDH) in Changzheng Hospital of Naval Medical University were selected as the study group, and 50 healthy volunteers were selected as the control group. The maximum height and width of the L₄/L₅ and L₅/S₁ interlaminar space were measured on anterolateral and lateral lumbar roentgenographs, and the pedicle length and angle and the minimum height and width of the foramen were measured on CT. The multiple correlation of stepwise multiple linear regression was used to determine the independent influence of related variables on the size of intervertebral foramen and intervertebral disc. Results There were no significant difference in pedicle length at L₄-S₁, foramina height and interlaminar height at L₄/L₅ and L₅/S₁ segments between the 2 groups(P>0.05). The abduction angle of S₁ pedicle in the study group was smaller than that in the control group. The L₄ pedicle head inclination angle in the study group was higher than that of the control group, and S₁ pedicle head inclination angle was lower than that of the control group. The differences of pedicle head inclination between L₄ and L₅, L₅ and S₁ were higher than those in the control group. Width of intervertebral foramen and lamina in L₄/L₅ and L₅/S₁ segments in the study group were smaller than those in the control group. There were significant differences in the above indexes(P<0.05). Pearson correlation analysis showed that age was negatively correlated with the height and width of the intervertebral lamina, as well as the height of the intervertebral foramen;the abduction angle of the pedicle was positively correlated with the width of the intervertebral lamina;length of the pedicle was positively correlated with the width of the intervertebral foramen;the difference of pedicle heads inclination angles between adjacent vertebrae was positively correlated with the width of the intervertebral foramen;the width of the intervertebral lamina was positively correlated with the width of the intervertebral foramen. Multiple linear regression analysis showed that the age, length and angle of the pedicle were independently correlated with the size of the intervertebral lamina and foramen. The abduction angle of the L₅ and S₁ pedicle was significantly positively correlated with the width of the intervertebral lamina, while the pedicle head inclination angle of L₅ was significantly negatively correlated with the height of the L₄/L₅ and L₅/S₁ intervertebral foramen. The difference of pedicle heads inclination angles between adjacent vertebrae was significantly positively correlated with the width of intervertebral foramen. Conclusions The height and width of interbody and intervertebral foramen will decrease with the patient''s age, and the width of intervertebral lamina will increase with the increase of the abduction angle of L₅ and S₁ pedicle. The greater the head inclination angle of L₅ pedicle, the smaller the height of adjacent intervertebral foramen. With the increase of the difference of pedicle heads inclination angle between adjacent vertebrae, the width of intervertebral foramen increases. The angle and length of the pedicle affect the size of the interlaminar space and foramen, and these changes may affect the difficulty of surgery and the selection of surgical methods.