基于椎体间成角的下腰椎峡部裂性滑脱分型系统的提出及其在后路椎体间融合术中应用价值的验证  

Classification system for spondylolisthmic spondylolisthesis based on intervertebral angulation and its application in posterior intervertebral fusion

作　　者：许星柱 袁鸿儒 杨浦鑫 刘庆涛 戴辰杰 霍亚冲 徐佳欣[1] 张迪[1] 王辉[1] Xu Xingzhu;Yuan Hongru;Yang Puxin;Liu Qingtao;Dai Chenjie;Huo Yachong;Xu Jiaxin;Zhang Di;Wang Hui(Department of Spine,the Third Hospital of Hebei Medical University,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第三医院脊柱科,石家庄050051

出　　处：《中华解剖与临床杂志》2025年第3期189-195,共7页Chinese Journal of Anatomy and Clinics

基　　金：河北省自然科学基金(H2022206056);河北省医学科学研究重点科技研究项目(20241617);河北省科技厅重大科技专项(22377707D)。

摘　　要：目的提出一种基于椎体间成角的下腰椎峡部裂性滑脱新分型系统,并探讨其在后路椎体间融合术中的应用价值。方法横断面研究。纳入2022年1月—2023年10月在河北医科大学第三医院脊柱外科行后路椎体间融合术治疗的下腰椎(L4、L5)峡部裂性滑脱患者92例,其中男21例、女71例,年龄为12~73(52.9±10.9)岁,体质量指数(BMI)为18.7~34.5(26.2±3.3)kg/m2。依据滑脱椎体下终板与下位椎体上终板的位置关系进行分型:两终板成角并开口向腹侧为1型、两终板平行为2型、两终板成角并开口向背侧为3型;再依据滑脱椎体下终板与下位椎体上终板是否接触各分型又进一步分为A亚型(未接触)和B亚型(部分接触或完全贴合)。观察并比较3个分型及2个亚型患者的手术时间、出血量及滑脱复位率;以滑脱Meyerding分度、滑脱部位进一步分层比较不同分型患者的基线资料、手术时间、术中出血量及滑脱复位率。结果(1)92例患者中,1型49例、2型25例、3型18例,A亚型55例、B亚型37例,手术均顺利完成。1~3型患者间年龄、BMI比较,差异均无统计学意义(P值均>0.05)。1~3型患者间手术时间、出血量和滑脱复位率比较,差异均有统计学意义(F=5.59、3.26、37.10,P值均<0.05);组内两两比较,3型患者的手术时间、出血量高于其他两型,滑脱复位率低于其他两型,差异均有统计学意义(P值均<0.05)。1型、2型患者中A亚型的手术时间、出血量和滑脱复位率均小于B亚型,3型患者中A亚型的手术时间、出血量均小于B亚型,差异均有统计学意义(P值均<0.05);3型患者中A亚型与B亚型的滑脱复位率比较,差异无统计学意义(P>0.05)。(2)依据滑脱Meyerding分度进行分层,Ⅰ、Ⅱ度滑脱患者手术时间、出血量及Ⅰ度滑脱患者滑脱复位率1~3型间比较,差异均无统计学意义(P值均>0.05)。Ⅱ度滑脱患者的滑脱复位率1~3型间比较差异具有统计学意义(F=30.05,P<0.0Objective This study aimed to propose a new classification system for spondylolisthmic spondylolisthesis based on intervertebral angulation and discuss its application in posterior intervertebral fusion.Methods This study is a cross-sectional study.Ninety-two patients with isthmic spondylolisthesis of lower lumbar spine(L4,L5)treated by spinal surgery in the Third Hospital of Hebei Medical University from January 2022 to October 2023 were retrospectively included.These patients were composed of 21 males and 71 females aged 12-73(52.9±10.9)years old,with a BMI of 18.7-34.5(26.2±3.3)kg/m2.The two endplates were angulated in accordance with the position relationship between the lower endplates and the upper endplates of the lower vertebrae(angulation between the vertebrae),and the opening to the ventral side was type 1.The two endplates were flat behavior type 2,and they were angulated.The opening to the dorsal side was type 3.Subtypes A(no contact)and B(partial contact or complete contact)were further divided on the basis of whether the lower endplate of the spondylolisthesis was in contact with the upper endplate of the lower vertebra.All patients underwent posterior interbody fusion.The operation time,blood loss,and reduction rate of slippage were observed and compared in the three subtypes and two subtypes.The baseline data,operation time,blood loss,and reduction rate of spondylolisthesis were compared using Meyerding scale and the location of spondylolisthesis.Results(1)Among the 92 patients,49 were type 1,25 were type 2,and 18 were type 3.Fifty-five patients of type A and 37 patients of type B were successfully operated.No statistically significant difference was found in the age and BMI among the groups with types 1-3(all P values>0.05).Statistically significant differences were observed in terms of surgical time,blood loss,and slip reduction rate among types 1-3(F=5.59,3.26,and 37.10;all P values<0.05).Pairwise comparison within the group showed that the surgical time and blood loss of type 3 patients were

关 键 词：脊椎滑脱 腰椎峡部裂性滑脱 椎间成角 分型 

分 类 号：R687.3[医药卫生—骨科学]