峡部裂性与退变性腰椎滑脱患者腰椎退变程度的影像学比较研究  

A comparative imaging study of the degree of lumbar vertebrae degeneration of isthmic spondy lolisthesis versus degenerative spondylolisthesis

作　　者：鄢来军 葛海雅 周斌[1] 袁宏杰 詹红生[2] YAN Laijun;GE Haiya;ZHOU Bin;YUAN Hongjie;ZHAN Hongsheng(Nantong Hospital of Traditional Chinese Medicine,Nantong 226000,Jiangsu,China)

机构地区：[1]南通市中医院,江苏南通226000 [2]上海中医药大学附属曙光医院,上海201203

出　　处：《中医正骨》2023年第2期15-21,共7页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：詹红生2022年全国名老中医药专家传承工作室建设项目(国中医药人教函〔2022〕75号);上海市2020年度“科技创新行动计划”医学创新研究专项项目(20MC1920600);上海市临床重点专科建设项目(shslczdzk03901);南通市卫生和计划生育委员会科研课题(QA2021025);上海中医药大学附属曙光医院第二轮《促进市级医院临床技能与临床创新三年行动计划》重大临床研究项目(SHDC2020CR1051B)。

摘　　要：目的:比较峡部裂性与退变性腰椎滑脱患者的腰椎退变程度。方法:回顾性分析2015年1月至2022年3月在南通市中医院收治的170例腰椎滑脱患者的病例资料,其中峡部裂性滑脱85例(峡部裂组)、退变性滑脱85例(退变组)。在腰椎侧位X线片上采用Meyerding分级标准评估腰椎滑脱程度;在腰椎MRI上采用Pfirrmann分级标准评估椎间盘退变程度,采用Modic改变分级标准评估终板退变程度,采用Weishaupt分级标准评估关节突关节退变程度。比较2组患者的腰椎滑脱Meyerding分级、椎间盘Pfirrmann分级、终板Modic改变分级及关节突关节Weishaupt分级。结果:①腰椎滑脱Meyerding分级。峡部裂组腰椎滑脱MeyerdingⅠ度32例、Ⅱ度48例、Ⅲ度5例,退变组腰椎滑脱MeyerdingⅠ度59例、Ⅱ度26例;峡部裂组腰椎滑脱程度较退变组更严重(Z=-4.323,P=0.000)。②椎间盘Pfirrmann分级。峡部裂组椎间盘Pfirrmann Ⅲ级43例、Ⅳ级34例、Ⅴ级8例,退变组椎间盘Pfirrmann Ⅲ级33例、Ⅳ级47例、Ⅴ级5例;2组患者椎间盘退变程度比较,差异无统计学意义(Z=-1.121,P=0.262)。③终板Modic改变分级。峡部裂组终板Modic0级18例、Ⅰ级7例、Ⅱ级46例、Ⅲ级14例,退变组终板Modic0级27例、Ⅰ级6例、Ⅱ级47例、Ⅲ级5例;峡部裂组终板退变程度较退变组更严重(Z=-2.051,P=0.040)。④关节突关节Weishaupt分级。峡部裂组关节突关节Weishaupt 0级2例、Ⅰ级27例、Ⅱ级33例、Ⅲ级23例,退变组关节突关节WeishauptⅠ级25例、Ⅱ级30例、Ⅲ级30例;2组患者关节突关节退变程度比较,差异无统计学意义(Z=-1.140,P=0.254)。结论:峡部裂性腰椎滑脱患者与退变性腰椎滑脱患者的椎间盘与关节突关节退变程度相似,但前者的腰椎滑脱和终板退变程度较后者更严重。Objective:To compare the degree of lumbar vertebrae degeneration between patients with isthmic spondylolisthesis(IS)and patients with degenerative spondylolisthesis(DS).Methods:The medical data of 170 patients with spondylolisthesis admitted to Nantong Hospital of Traditional Chinese Medicine from January 2015 to March 2022 were retrospectively analyzed,including 85 cases with IS(IS group)and 85 cases with DS(DS group).The degree of lumbar spondylolisthesis was evaluated by using Meyerding d asfiationi criteria on lateral radiographs of lumbar vertebrae.The Pirrmann grading scale was used to assess the degree of intervertebral disc degeneration on lumbar magnetic resonance imaging(MRI)images.The Modic changes lassification method was employed to evaluate the degree of verte-bral endplate degeneration.The degree of facet joint degeneration was assed using the weishaupt scale.Meyerding gading of lumbar spondylolisthesis,Pfirrmann gading of interv ertebral disc,Modic change grading of vertebral endplate,and w eishaupt grading of facet joint were compared between the two groupe.Results:①Meyerding grading of lumbar spondylolisthesis.In the IS goup,there wen 32 cases of Meyerding grade I,48 cases of grade II,and 5 cases of grade II;while in the DS group,there were 59 cases of Meyerding grade I and 26 cases of gnade II.The spondylolisthesis was more severe in the IS group than in the Ds group(Z=-4.323,P=0.000).②Pfirmann grading of intervertebral disc.In the IS group,there we 43 cases of Pfirmann grade I,34 cases of gradeIV,and 8 cases of gndeV;and there were 33 cases of Pfirrmann gradell,47 cases of gradeIV,and5 cases of grade V in the DS group.There was no si gnifcant difference in the degree of intervertebral disc degeneration between the two groups(Z=-1.121,P=0.262).③Modic change grading of vertebral endplate.In the IS group,there were 18 cases of Modic type-0,7 cases of type-I,46 cases of type-II,and 14 cases of type-I;while in the DS group,there were 27 cases of Modic type-0,6 cases of type-I,47 cases of type

关 键 词：脊椎滑脱 腰椎 椎间盘退化 放射摄影术 磁共振成像 

分 类 号：R687.3[医药卫生—骨科学]