退变性腰椎滑脱患者L4, 5关节突关节的形态学特点  

Morphological characteristics of L4,5 facet joints in degenerative lumbar spondylolisthesis

作　　者：冷叶波 唐超 钟德君 何宝强 廖烨晖 马飞 唐强 王清 Leng Yebo;Tang Chao;Zhong Dejun;He Baoqiang;Liao Yehui;Ma Fei;Tang Qiang;Wang Qing(Department of Orthopaedics,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院骨科,泸州646000

出　　处：《中华骨科杂志》2023年第8期508-515,共8页Chinese Journal of Orthopaedics

摘　　要：目的基于Roussouly分型观察不同脊柱骨盆类型的退变性腰椎滑脱(degenerative lumbar spondylolisthesis, DLS)患者L4, 5关节突关节的形态学特点。方法回顾性分析2018年8月至2022年5月于西南医科大学附属医院骨科就诊的142例DLS患者资料, 男33例, 年龄(65.0±10.7)岁;女109例, 年龄(61.8±9.6)岁。在CT图像上测量L4, 5关节突关节的形态学参数:关节突关节角(facet joint angle, FJA)、椎弓根-关节突关节角(pedicle facet angle, PFA)、关节突关节的不对称性(facet joint tropism, FT)和关节突关节的骨关节炎(osteoarthritis, OA)程度;在术前站立中立位腰椎侧位X线片上测量骶骨倾斜角(sacral slope, SS)、腰椎前凸角(lumbar lordosis, LL)、L4椎体滑移程度(percentage of slip distance, SDP)。根据Roussouly分型将患者分为四组(Ⅰ、Ⅱ、Ⅲ和Ⅳ型), 比较各组间关节突关节形态学参数和SDP的差异, 并分析FJA与PFA的相关性。结果 142例患者, RoussoulyⅠ型28例、Ⅱ型50例、Ⅲ型43例和Ⅳ型21例。Ⅰ、Ⅱ、Ⅲ和Ⅳ型的SDP分别为19.1%±3.4%、18.6%±3.9%、21.7%±3.9%、25.0%±2.4%, 除Ⅰ、Ⅱ型外, 其余各型两两比较差异均有统计学意义(P<0.05)。Ⅰ、Ⅱ型的FJA(31.4°±6.3°、35.2°±6.8°)均大于Ⅲ型(28.4°±5.6°)和Ⅳ型(23.4°±4.5°), 且Ⅲ型的FJA大于Ⅳ型、Ⅰ型小于Ⅱ型, 差异均有统计学意义(P<0.05)。Ⅰ、Ⅱ型的PFA(113.9°±4.9°、111.3°±5.6°)均小于Ⅲ型(116.3°±4.4°)和Ⅳ型(121.8°±3.5°), 且Ⅲ型的PFA小于Ⅳ型、Ⅰ型大于Ⅱ型, 差异均有统计学意义(P<0.05)。Ⅰ、Ⅱ型的OA分度均小于Ⅲ、Ⅳ型, 差异有统计学意义(P<0.05);而Ⅰ型与Ⅱ型, 以及Ⅲ型与Ⅳ型的OA分度差异无统计学意义(P>0.05)。Ⅰ、Ⅱ、Ⅲ和Ⅳ型的FT(5.8°±2.3°、5.6°±2.4°、6.1°±1.8°、5.9°±1.9°)差异无统计学意义(F=0.40, P=0.752)。Pearson相关分析提示, FJA与PFA呈负相关(r=-0.68, P<0.001)。结论在退变性腰椎滑脱节段, 关节突�Objective To observe the morphological characteristics of L4,5 facet joints in patients with degenerative lumbar spondylolisthesis(DLS)of different spinopelvic types based on Roussouly classification.Methods We retrospectively analyzed 142 patients with DLS who visited the department of orthopaedics in the Affiliated Hospital of Southwest Medical University from August 2018 to May 2022.There were 33 males aged 65.0±10.7 years and 109 females aged 61.8±9.6 years.The following morphological parameters of the L4,5 facet joint were measured on the CT images:facet joint angle(FJA),pedicle facet angle(PFA),facet joint tropism(FT)and facet joint osteoarthritis(OA)degree;the sacral slope(SS),lumbar lordosis(LL)and percentage of L4 slip distance(SDP)were measured on preoperative standing neutral lumbar radiographs.According to the Roussouly classification,the patients were divided into four groups(type I,type II,type III,and type IV).The differences of morphological parameters of the facet joints and SDP were compared among the four groups,and the correlation between the FJA and PFA was analyzed.Results There were 142 patients,including 28 type I,50 type II,43 type III,and 21 type IV according to the Roussouly classification.The SDPs of type I,type II,type III,and type IV were 19.1%±3.4%,18.6%±3.9%,21.7%±3.9%,25.0%±2.4%,respectively.Except for types I and II,there were statistically significant differences in pairwise comparison among all other types(P<0.05).The FJAs in type I and type II(31.4°±6.3°,35.2°±6.8°)were larger than those in type III(28.4°±5.6°)and type IV(23.4°±4.5°),and the FJA in type III was larger than that in type IV.Conversely,the FJA in type I was smaller than that in type II.These differences were statistically significant(P<0.05).The PFAs in type I and type II(113.9°±4.9°,111.3°±5.6°)were smaller than those in type III(116.3°±4.4°)and type IV(121.8°±3.5°),and the PFA in type III was smaller than that in type IV,while,the PFA in type I was larger than that in type II.These

关 键 词：腰椎 椎间盘退行性变 脊椎滑脱 椎关节突关节 

分 类 号：R681.5[医药卫生—骨科学]