腰骶部骨性参数对退变性腰椎滑脱发生与发展及术后复位的影响  

Influences of lumbosacral bone parameters on the occurrence and progress even postoperative reduction of degenerative lumbar spondylolisthesis

作　　者：孙泽豪 杨森 李天佐 王炳武[2] 张忠礼[2] 史玉林[2] SUN Zehao;YANG Sen;LI Tianzuo;WANG Bingwu;ZHANG Zhongli;SHI Yulin(Department of Surgery,Weifang Medical University,Weifang 261053,China;Department of Spine Orthopaedics,Weifang People’s Hospital)

机构地区：[1]潍坊医学院外科学教研室,山东潍坊261053 [2]潍坊市人民医院脊柱外科

出　　处：《潍坊医学院学报》2021年第3期188-191,共4页Acta Academiae Medicinae Weifang

基　　金：潍坊市卫生计生委科研计划项目(项目编号:wfwsjs-2018-020)。

摘　　要：目的探究腰骶部骨性参数对退变性腰椎滑脱发生与发展及术后复位的影响,对退变性腰椎滑脱的早期诊断、干预、治疗及手术方式的选择有所提示。方法回顾性分析2018年3月~2020年3月在我院脊柱外科二区经治的60例L4退变性滑脱患者的临床资料,组成退变性滑脱组(DS组)。所选患者均通过采集病史、体格检查和影像学检查明确诊断。采用以下临床指标对所有患者进行评估,主要包括骨盆倾斜角(PT)、骨盆入射角(PI)、L4椎体相对倾斜角(L4RI)、腰椎前凸角(LL)、L4-5关节突关节角、L4椎体术前术后滑脱率、术后复位率等。结果滑脱组骨盆倾斜角为(23.45±5.01)°,骨盆入射角为(53.81±6.08)°,L4椎体相对倾斜角为(15.51±4.60)°,腰椎前凸角为(46.82±5.64)°,左侧小关节突冠状面角(67.11±2.17)°,右侧小关节突冠状面角为(67.86±3.50)°,平均小关节突冠状面角为(67.48±2.17)°,L4椎体术前滑脱率为(12.22±2.66)%,复位率为(76.65±16.03)%.退变性腰椎滑脱组与非滑脱组比较,退变性腰椎滑脱组的骨盆入射角较大(P<0.05)、L4椎体相对倾斜角较大(P<0.05)、腰椎前凸角较大(P<0.05)、小关节突关节面更偏向于冠状面(P<0.05)。骨盆入射角与L4椎体术前滑脱率呈正相关(r=0.277,P<0.05),L4椎体相对倾斜角与L4椎体术前滑脱率呈正相关(r=0.37,P<0.01),骨盆入射角与术后复位率呈负相关(r=-0.278,P<0.05),术前滑脱率与术后复位率呈负相关(r=-0.337,P<0.05)。结论退变性腰椎滑脱的风险因素可能与骨盆入射角、L4椎体相关倾斜角、小关节突关节角有关。术前的滑脱程度与骨盆入射角、L4椎体相对倾斜角有关。术后复位率与骨盆入射角、术前滑脱率有关。Objective To investigate the influence of lumbosacral bony parameters on the occurrence and development of degenerative lumbar spondylolisthesis and postoperative repositioning, with hints on the early diagnosis, intervention, treatment, and choice of surgical modality for degenerative lumbar spondylolisthesis.Methods Retrospective analysis of the clinical data of 60 patients with the degenerative slip of L4 who were treated in our spine surgery department II from March 2018 to March 2020,forming the degenerative slip group(DS group).The selected patients were clearly diagnosed by taking a medical history, physical examination, and imaging.The following clinical indicators were used to evaluate all patients, mainly including pelvic tilt angle(PT),pelvic incidence angle(PI),L4 vertebral body relative tilt angle(L4 RI),lumbar lordosis angle(LL),L4-5 articular eminence joint angle, preoperative and postoperative slippage rate of L4 vertebral body, and postoperative repositioning rate.Results In the slipped group, the pelvic tilt angle was(23.45±5.01)°,the pelvic incidence angle was(53.81±6.08)°,the relative tilt angle of the L4 vertebra was(15.51±4.60)°,the anterior lumbar convexity angle was(46.82±5.64)°,the coronal plane angle of the left lesser trochanter was(67.11±2.17)°,the coronal plane angle of the right lesser trochanter was(67.86±3.50)°,and the mean lesser trochanter coronal plane angle was(67.48±2.17)°,and the mean coronal plane angle of the lesser articular eminence were(67.48±2.17)°.The preoperative slippage rate of the L4 vertebral body was(12.22±2.66)%,and the restoration rate was(76.65±16.03)%.The degenerative lumbar slipped group had a greater pelvic incidence angle(P<0.05),a greater relative tilt angle of the L4 vertebral body(P<0.05),a greater anterior lumbar convexity angle(P<0.05),and a more coronal articular surface of the lesser articular eminence(P<0.05) compared with the non-slipped group.The pelvic incidence angle was positively correlated with the preoperative slip rate of

关 键 词：退变性腰椎滑脱 解剖标志 影响因素分析 

分 类 号：R681.53[医药卫生—骨科学]