L_4 退变性滑脱患者脊柱-骨盆矢状面参数的特点与相关性分析  

The characteristics and correlation study of spinopelvic sagittal parameters in patients with L_4 degenerative spondylolisthesis

作　　者：张琨[1] 张奎渤[2] 李泽民[3] 蔡国栋[1] 樊云山 袁继龙[1] 王俊勤[1] 

机构地区：[1]泰山医学院附属医院骨科,山东泰安271000 [2]中山大学附属第五医院骨外科,广东珠海519000 [3]中山大学附属第一医院脊柱外科,广州510080

出　　处：《中国矫形外科杂志》2015年第17期1600-1604,共5页Orthopedic Journal of China

基　　金：广东省自然科学基金项目(编号:S2011040002494);中山大学临床医学研究5010计划项目(编号:2012005)

摘　　要：[目的]探讨L4退变性滑脱患者脊柱-骨盆矢状面参数的特点及各参数之间的相关性。[方法]回顾性分析2011年1月∽2014年6月间44例L4单节段退变性滑脱患者的临床资料,并选取41例健康志愿者做为对照。在站立位脊柱侧位X线片上进行矢状面参数的测量（包括骨盆入射角PI、骨盆倾斜角PT、骶骨倾斜角SS、腰椎前凸角LL、矢状面轴向垂直距离SVA及T1骨盆角TPA等）。按PI大小进行分组对比,并观察腰椎矢状面曲度的Roussouly分型。[结果]DS组的PI、PT〉NC组,SS0.05）。在DS组中进一步发现：正常PI亚组的PT、TPA均大于NC组及大PI亚组的相应值,而SS均小于NC组及大PI亚组（P〈0.05）。按Roussouly分型,NC组中1∽4型所占比例分别为9.8%、56.1%、26.8%和7.3%;DS组中1∽4型的比例分别为4.5%、25%、43.2%和27.3%。相关性分析显示：两组中均可见PI与PT、SS存在密切相关性（P〈0.05）;而TPA与PI、PT、LL及SVA之间有密切相关性（P〈0.05）。[结论]L4退变性滑脱患者较正常人群的骨盆入射角更大,且存在骨盆后倾的代偿机制;T1骨盆角是评价患者整体矢状面平衡的理想指标。[ Objective] To investigate the characteristics and correlation of spinopelvic sagittal parameters in patients with L4 degenerative spondyMisthesis （DS） . [ Methods ] From January 2011 to June 2014, a total of 44 patients with L4 DS and 41 asymptomatic volunteers were enrolled. The spinopelvic sagittal parameters including pelvic incidence （PI）, pelvic tilt （PT）, sacral slope （SS）, lumbar lordosis （LL）, sagittal vertical axis （SVA） and T1 pelvic angle （TPA） were measured in standard lateral spine radiographs. All cases were stratified according to the PI value and Roussouly classification for the lumbar lordosis curvature. [ Results] Compared with the normal group, L4 DS group showed significantly greater PI, PT and smaller SS. The LL, SVA and TPA showed no significant difference between the two groups. In DS patients, the PT and TPA were sig- nificantly higher, but SS were significantly lower in the normal PI group than in the NC and large PI group （ P 〈 0. 05 ）. Ac- cording to the Roussouly classification, the distribution of NC group was： 9.8% type 1, 56. 1% type 2, 26. 8% type 3 and 7.3% type 4; while the DS group was： 4. 5% type 1, 25% type 2, 43.2% type 3 and 27.3% type 4. Additionally, PI was correlated well with the PT and SS in both groups （ P 〈 0.05 ） , TPA had a significant correlation with PI, PT, LL and SVA （ P 〈 0.05 ） . [ Conclusion ] Pelvic incidence is higher in patients with L4 DS than the normal population. Retroverted pelvic contribute to the compensatory mechanism. The T1 pelvic angle is a useful parameter for evaluating the global sagittal spine balance in DS patients.

关 键 词：腰椎滑脱 脊柱-骨盆矢状面参数 矢状面平衡 

分 类 号：R687.3[医药卫生—骨科学]