基于脊柱骨盆参数探讨腰椎峡部裂患者椎弓根-关节突的形态特点及临床意义  

Analyzing the morphologic characteristics of pedicle-facet joints in lumbar spondylolysis:correlation with spinopelvic parameters and its clinical relevance

作　　者：何宝强 冷叶波 钟德君 李洋 廖烨晖 唐强 唐超 马飞 王清 He Baoqiang;Leng Yebo;Zhong Dejun;Li Yang;Liao Yehui;Tang Qiang;Tang Chao;Ma Fei;Wang Qing(Department of Orthopaedics,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Ortho⁃paedics,Meishan Tianfu New Area People's Hospital,Meishan 620564,China)

机构地区：[1]西南医科大学附属医院骨科,泸州646000 [2]眉山天府新区人民医院骨科,眉山620564

出　　处：《中华骨科杂志》2024年第3期177-185,共9页Chinese Journal of Orthopaedics

基　　金：四川省医学会科研课题计划(S17075);四川省医学青年创新科研课题计划(Q22008、Q21005);泸州市人民政府与西南医科大学科技战略合作项目(2020LZXNYDJ22)

摘　　要：目的基于脊柱骨盆参数分析腰椎峡部裂患者椎弓根-关节突形态学特点,并探讨其临床意义。方法纳入2020年5月至2023年1月于西南医科大学附属医院就诊的L_(5)峡部裂患者121例(峡部裂组)、L_(4,5)退行性滑脱患者108例(滑脱组)以及L_(4,5)正常但L_(5)S_(1)椎间盘突出的患者100例(对照组),均行腰椎X线片及CT三维重建检查。在站立中立位腰椎侧位X线片上测量椎体滑移率(percentage of slip,SP)和脊柱骨盆参数,包括骶骨倾斜角(sacral slope,SS)和腰椎前凸角(lumbar lordosis,LL)。在腰椎CT三维重建像上测量L_(4)和L_(5)椎弓根-关节突关节的形态参数,包括关节突关节角(facet joint angle,FJA)、椎弓根-关节突关节角(pedicle facet angle,PFA)、关节突关节骨关节炎(osteoarthritis,OA)分级和关节突关节不对称性(facet joint tropism,FT)。比较峡部裂组、滑脱组和对照组脊柱骨盆参数、椎弓根-关节突关节形态参数的差异,分析各组组内脊柱骨盆参数和L_(4)和L_(5)椎弓根-关节突关节形态参数的相关性,比较各组内L_(4)和L_(5)椎弓根-关节突关节形态参数的差异。结果峡部裂组、滑脱组和对照组患者SS、LL的差异有统计学意义(F=21.910,P<0.001;F=22.439,P<0.001),峡部裂组患者SS、LL最大,滑脱组次之,对照组最小。三组间椎弓根-关节突关节形态参数比较结果显示,峡部裂组L_(4)FJA最大,对照组次之,滑脱组最小(F=344.791,P<0.001);滑脱组L_(4)PFA最大,峡部裂组次之,对照组最小(F=193.725,P<0.001);滑脱组L_(4)关节突关节OA分级明显重于峡部裂组和对照组(H=467.925,P<0.001),而峡部裂组与对照组的差异无统计学意义(P>0.05)。Pearson相关分析表明,各组内SS、LL与FJA均呈负相关,而SS、LL与PFA均呈正相关(P<0.05);各组内L_(4)FJA均小于L_(5),L_(4)PFA均大于L_(5),差异有统计学意义(P<0.05);峡部裂组L_(4)关节突关节OA分级明显轻于L_(5)(Z=7.043,P<0.001),滑脱组L_(4)关节突关节OA分�Objective To delineate the morphological features of pedicle-facet joints in lumbar spondylolysis patients,correlating these with spinopelvic parameters to explore their mechanisms and clinical implications.Methods This study enrolled 121 patients with L_(5)spondylolysis(IS group),108 with L_(4,5)degenerative spondylolisthesis(DS group),and 100 with normal L_(4,5)but L_(5)S_(1)lumbar disc herniation(NL group),who underwent radiography and multislice spiral CT from May 2020 to January 2023.Parameters including vertebral slip percentage(SP)and spinopelvic alignments,such as sacral slope and lumbar lordosis,were quantified using standing lateral lumbar radiographs.Morphological parameters of the L_(4)and L_(5)facet joints were measured on 3D reconstructed lumbar CT images,including the facet joint angle(FJA),pedicle-facet joint angle(PFA),facet joint osteoarthritis(OA),and facet joint tropism(FT).Results The analysis revealed significant variances in SS and LL among the groups(F=21.910,P<0.001;F=22.439,P<0.001).The IS group exhibited the highest SS and LL,followed by the DS and NL groups.Morphological assessments showed the largest L_(4)FJA in the IS group,with progressive decreases in the DS and NL groups(F=344.791,P<0.001).Conversely,L_(4)PFA was greatest in the DS group(F=193.725,P<0.001).Notably,L_(4)OA was markedly more severe in the DS group compared to IS and NL groups(H=467.925,P<0.001),with no significant disparity between IS and NL groups(P>0.05).Correlation analyses within each cohort highlighted a negative association of sacral slope and lumbar lordosis with facet joint angles,yet a positive correlation with pedicle-facet joint angles both with statistical significance(P<0.05).Furthermore,L_(4)facet joint angles were consistently smaller than those at L_(5),and L_(4)pedicle-facet joint angles were larger than L_(5)(P<0.05).Osteoarthritis at L_(5)was more pronounced in the IS group compared to L_(4)(Z=7.043,P<0.001),a trend inversely observed in the DS group(Z=11.868,P<0.001),while the NL group showed no

关 键 词：腰椎 脊椎滑脱 椎关节突关节 生物力学现象 

分 类 号：R687.3[医药卫生—骨科学] R681.5[医药卫生—外科学]