腰椎侧方不稳在退变性腰椎滑脱中的临床相关研究  

Clinical study of lumbar lateral instability in degenerative lumbar spondylolisthesis

作　　者：汪颖峰[1] 胡鸣[1] 罗俊杰[1] 韩建邦[1] 黄定安[1] 陈曦[2] 蔡海平 牛雷 江将 WANG Ying-feng;HU Ming;LUO Jun-jie;HAN Jian-bang;HUANG Ding-an;CHEN Xi;CAI Hai-ping;NIU Lei;JIANG Jiang(Department of Orthopedics,Huangshan People’s Hospital,Huangshan,Anhui 245000,China;Department of Orthopedics,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei,Anhui 230001,China)

机构地区：[1]黄山市人民医院骨科,安徽黄山245000 [2]中国科学技术大学附属第一医院(安徽省立医院)骨科,安徽合肥230001

出　　处：《颈腰痛杂志》2024年第2期252-257,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：黄山市科技计划项目(编号:2020KN-13)。

摘　　要：目的探讨腰椎侧方不稳在退变性腰椎滑脱中的影像学特征及其对手术疗效的影响。方法回顾性分析2019年2月~2022年5月在本院接受手术治疗且随访>2年的97例退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)患者。根据在术前腰椎X线片上是否伴有腰椎侧方不稳(lumbar lateral instability,LLI)现象,将被纳入的患者分为侧方不稳定组(L组)和非侧方不稳定组(NL组)。记录两组患者术前、术后以及末次随访时的生活质量评估结果及矢状面和冠状面影像学参数。结果本研究有22例(22.7%)患者伴有LLI现象。L组患者术前滑脱角、腰椎冠状面平衡距离、L_(4)倾斜角和椎间隙楔变角均显著高于NL组,且L组患者腰椎前凸角度丢失更为严重(P<0.05)。术后及末次随访时,两组患者矢状面和冠状面参数无显著差异,且两组患者术后的生活质量均得到了显著提高。结论伴有LLI的DLS患者是一个与腰椎不稳定相关的独特亚群,手术治疗可有效改善伴LLI患者的冠状面形态。Objective To investigate the radiographic characteristics and surgical effect of lumbar lateral instability(LLI)in degenerative lumbar spondylolisthesis(DLS).Methods The clinical data of 97 patients who underwent surgery for degenerative spondylolisthesis between February 2019 and May 2020 were retrospectively analyzed and compared.According to the grouping standard of whether or not lumbar lateral instability was noted in preoperative X-rays,the enrolled patients were divided into the L group and NL group.The sagittal and coronal planes parameters,patient reported outcomes of the two groups were recorded.Results As many as 22.7%(22 out of 97)of patients with degenerative lumbar spondylolisthesis were detected to have lumbar lateral instability.The preoperative slip angle(SA),lumbar coronal balance(LCB),L 4 tilting angle(L_(4)TA)and disc wedging angle(DWA)in group L were significantly higher than those in group NL(P<0.05).The lumbar lordosis angle(LL)in group L was significantly lower than that in group NL.After surgery both the L group and NL group got significant improvements in health-related quality of life and radiographic parameters compared with those before operation.Conclusion DLS patients with a LLI phenomenon are a distinct subgroup associated with lumbar instability.Surgical intervention is effective for correction of coronal morphology in LLI patients.

关 键 词：下腰部疼痛 退变性腰椎滑脱 腰椎侧方不稳 经椎间孔椎体间融合 

分 类 号：R681.5[医药卫生—骨科学]