| 周庆双,陈 曦,孙 旭,徐 亮,杜长志,王牧一,杨 柏,朱泽章,王 斌,邱 勇.后凸型低度退变性腰椎滑脱脊柱-骨盆矢状面形态特点及临床意义[J].中国脊柱脊髓杂志,2019,(5):431-436. |
| 后凸型低度退变性腰椎滑脱脊柱-骨盆矢状面形态特点及临床意义 |
| 中文关键词: 退变性腰椎滑脱 椎间隙高度 滑脱角 生活质量 |
| 中文摘要: |
| 【摘要】 目的：探讨退变性腰椎滑脱节段呈后凸形态对滑移参数和脊柱-骨盆矢状面形态的影响及临床意义。方法：回顾性分析2013年1月～2016年4月在我院就诊的165例Ⅰ~Ⅱ度L4/5退变性滑脱患者，其中男29例，女136例，年龄42~72岁（平均54.3±11.9岁）。根据站立位全脊柱侧位X线片滑脱节段椎间隙的形态将患者分为后凸型滑脱组和非后凸型滑脱组。测量的滑脱参数包括滑脱率、滑脱角、前/后椎间隙高度及滑脱节段滑脱率、滑脱角活动度；矢状面参数包括骨盆入射角、骨盆倾斜角、骶骨倾斜角、胸椎后凸角、腰椎前凸角、矢状面垂直距离；同时通过疼痛视觉模拟评分（visual analogue scale/score，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）评估患者生活质量。采用独立样本t检验比较两组之间影像学和生活质量评估指标的差异。结果：21（12.7%）例为后凸型滑脱，其年龄显著高于非后凸型滑脱组（60.7±13.6 vs 53.4±11.9，P<0.05）。后凸型滑脱组滑脱角明显低于非后凸型滑脱组（-3.2°±2.4° vs 7.3°±4.3°，P<0.001），而滑脱率明显高于非后凸型滑脱组[（22.4±4.4）% vs （18.9±3.8）%，P<0.001]。后凸型滑脱组前方椎间隙高度显著低于非后凸型滑脱组（P<0.001），而后方椎间隙高度显著高于非后凸型滑脱组（P<0.01)。后凸型滑脱组滑脱节段滑脱率和滑脱角活动度均显著高于非后凸型滑脱组（P<0.001）。后凸型滑脱组骨盆倾斜角和矢状面垂直距离明显高于非后凸型滑脱组（P<0.01），而骶骨倾斜角和腰椎前凸角明显低于非后凸型滑脱组（P<0.05）。两组之间骨盆入射角和胸椎后凸角无统计学差异（P>0.05），而后凸型滑脱组骨盆入射角-腰椎前凸角显著高于非后凸型滑脱组（P<0.001）。后凸型滑脱组VAS腰痛、腿痛评分和ODI显著高于非后凸型滑脱组（P<0.05）。结论：L4/5退变性滑脱患者中约12.7%的患者为后凸型滑脱，较非后凸型滑脱患者表现出更为明显的腰椎前凸角丢失、骨盆后旋和躯干前倾，并导致生活质量降低。 |
Characteristics of spino-pelvic sagittal parameters in degenerative spondylolisthesis with kyphotic angulation and its clinical significance |
| 英文关键词:Degenerative spondylolisthesis Intervertebral space Slip angle Life quality |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the impact of kyphotic angulation at the olisthesis level on spondylolisthesis related parameters and spino-pelvic sagittal parameters in degenerative lumbar spondylolisthesis(DLS) and its clinical significance. Methods: A consecutive cohort of 165 patients with L4/5 DLS(Meyerding grade Ⅰ or Ⅱ) between January 2013 and April 2016 was reviewed, including 28 males and 131 females, with an average age of 54.3±11.9 years(42-72 years). The patients were divided into two groups, including the kyphotic group and the non-kyphotic group, based on the angulation profile of the olisthesis level. Radiographic parameters including slip percentage, slip angle, anterior and posterior disc height, range of motion, pelvic incidence(PI), pelvic tilt, sacral slop, thoracic kyphosis, lumbar lordosis(LL) and sagittal vertical axis were measured. Oswestry disability index(ODI) and visual analogue scale/score(VAS) were completed to evaluate quality of life. Radiographic parameters and scores of life quality were compared between two groups. Results: Kyphotic slip was detected in 21(12.7%) of the 165 patients and the average age of the kyphotic group was significantly older than that of the non-kyphotic group(60.7±13.6 vs 53.4±11.9 years, P<0.05). The slip angle was significantly lower in the kyphotic group(-3.2°±2.4° vs 7.3°±4.3°, P<0.001), while slip percentage was higher in the kyphotic group compared to the non-kyphotic group[(22.4±4.4)% vs (18.9±3.8)%, P<0.001]. Compared to the non-kyphotic group, anterior disc height was significantly lower in the kyphotic group(P<0.001), while posterior disc height was higher in the kyphotic group(P<0.01). Translational motion and angular motion in the kyphotic group were significantly higher than those in the non-kyphotic group(P<0.001). Pelvic tilt and sagittal vertical axis in the kyphotic group were significantly higher than those in the non-kyphotic group(P<0.001), and LL and sacral slop were significantly lower in the kyphotic group than those in the non-kyphotic group(P<0.01). There was no difference in PI and thoracic kyphosis between the two groups(P>0.05), while PI-LL in the kyphotic group was significantly higher than that in the non-kyphotic group(P<0.001). The preoperative ODI, VAS back pain and leg pain scores in the kyphotic slip group were significantly higher than those in the non-kyphotic slip group(P<0.05). Conclusions: Kyphotic slip was observed in 12.7% of L4/5 DLS patients and had significant impact on the slip parameters and spino-pelvic sagittal parameters, which could lead to decline of life quality. |
| 投稿时间：2018-12-12 修订日期：2019-05-09 |
| DOI： |
| 基金项目:国家自然科学基金（项目编号：81772422）；江苏省科技发展计划项目（项目编号：BE2017606） |
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