退变性和峡部裂性L5/S1滑脱患者L5椎弓根形态学参数比较及其临床意义  

Comparison of L5 pedicle morphological parameters between patients with L5/S1 degenerative and isthmic spondylolisthesis and its clinical significance

作　　者：唐超 冷叶波 廖烨晖 唐强 马飞 徐世财 王清 钟德君 TANG Chao;LENG Yebo;LIAO Yehui(Department of Orthopedics,the Affiliated Hospital of Southwest Medical University,Luzhou,646000,China;Department of Orthopedics,Xinqiao Hospital of Army Medical University(Third Military Medical University),Chongqing,400030,China)

机构地区：[1]西南医科大学附属医院骨科,四川省泸州市643200 [2]陆军军医大学新桥医院骨科,重庆市400030

出　　处：《中国脊柱脊髓杂志》2022年第11期1002-1009,共8页Chinese Journal of Spine and Spinal Cord

基　　金：四川省医学会青年创新科研课题(Q21005)。

摘　　要：目的:测量退变性和峡部裂性L5/S1滑脱患者的L5椎弓根形态学参数,比较两者的差异并分析其临床意义。方法:收集西南医科大学附属医院2016年1月1日~2020年6月30日收治的L5/S1滑脱症患者的影像学资料,其中峡部裂性L5/S1滑脱119例(IS组),退变性L5/S1滑脱45例(DS组),同时选取164例无腰椎滑脱的腰椎间盘突出症患者作为对照组(NS组)。在多层螺旋计算机断层扫描(MSCT)图像上测量三组患者L5椎弓根的形态学参数,包括椎弓根长度(PL)、椎弓根螺钉轨迹长度(PSTL)、椎弓根宽度(PW)、椎弓根高度(PH)和椎弓根内倾角度(PCA);在腰椎站立中立侧位X线片上测量L5椎体的滑移距离,并计算滑移百分比。比较三组患者L5椎弓根形态学参数的差异,分析形态学参数与滑移程度的相关性。结果:三组患者性别比、身高、体重和体重指数(BMI)无统计学差异(P>0.05)。三组患者各参数左右侧比较均无统计学差异,合并统计。IS组的PL、PSTL、PW、PH和PCA分别为14.4±2.1mm、48.3±4.2mm、13.6±2.1mm、9.6±1.5mm和29.7°±5.3°;DS组分别为16.2±1.6mm、49.8±3.3mm、11.3±1.9mm、9.7±1.7mm和23.3°±6.5°;NS组分别为15.1±1.7mm、48.5±3.5mm、12.7±1.9mm、10.8±1.3mm和27.3°±4.7°。DS组的PL、PSTL显著性大于IS组(P<0.05),PW和PCA显著性小于IS组(P<0.05),PH两组无统计学差异(P>0.05)。IS组PL、PW、PH、PCA与NS组比较有统计学差异(P<0.05),PSTL与NS组比较无统计学差异(P>0.05);DS组的PL、PSTL、PW、PH和PCA与NS组比较均有统计学差异(P<0.05)。IS组的滑移距离(11.2±2.7mm)和滑移百分比[(29.1±10.9)%]大于DS组[8.8±2.4mm、(24.4±8.4)%](P<0.05)。Pearson相关分析结果显示,IS组患者L5椎体滑移百分比和L5椎弓根各参数之间无显著相关性(P>0.05);DS组患者L5椎体的滑移百分比与PL呈正相关(r=0.640,P=0.0001),与PW(r=-0.510、P=0.0001)和PCA(r=-0.405、P=0.006)呈负相关,与PSTL无显著相关性(P>0.05)。结论:两类滑脱患者滑�Objectives:To measure the morphological parameters of L5 pedicle in patients with L5/S1 degenerative and isthmic spondylolisthesis,compare their differences and analyze their clinical significance.Methods:The imaging data of patients with L5/S1 spondylolisthesis admitted to the Affiliated Hospital of Southwest Medical University from January 1,2016 to June 30,2020 were collected.There were 119 patients with L5/S1 isthmic spondylolisthesis(IS group)and 45 patients with L5/S1 degenerative spondylolisthesis(DS group),and 164 non-spondylolisthesis patients with lumbar disc herniation were selected as the control group(NS group).The morphological parameters of L5 pedicle of the three groups of patients were measured on multi-slice computed tomography(MSCT)images,including pedicle length(PL),pedicle screw trajectory length(PSTL),pedicle width(PW),pedicle height(PH),and pedicle camber angle(PCA).The slipping distance of L5 vertebra was measured on standing neutral lateral X-ray film,and the percentage of slip was calculated.The differences of L5 pedicle morphological parameters between the three groups were compared,and the correlation between morphological parameters and slip degree was analyzed.Results:There was no significant difference in sex ratio,height,weight and body mass index(BMI)among the three groups of patients(P>0.05).There was no statistical difference between the left and right parameters of the three groups.The PL,PSTL,PW,PH,and PCA of IS,DS,and NS groups were respectively 14.4±2.1mm,48.3±4.2mm,13.6±2.1mm,9.6±1.5mm,and 29.7°±5.3°;16.2±1.6mm,49.8±3.3mm,11.3±1.9mm,9.7±1.7mm,and 23.3°±6.5°;15.1±1.7mm,48.5±3.5mm,12.7±1.9mm,10.8±1.3mm,and 27.3°±4.7°.The values of PL and PSTL in DS group were significantly higher than those in IS group(P<0.05),and the values of PW and PCA were significantly smaller than those in IS group(P<0.05),and there was no significant difference in PH between the two groups(P>0.05).There were significant differences in PL,PW,PH,PCA between IS group and NS group(P<0.

关 键 词：峡部裂性腰椎滑脱 退变性腰椎滑脱 椎弓根形态 影像学 相关性 

分 类 号：R681.5[医药卫生—骨科学] R816.8[医药卫生—外科学]