退变性腰椎滑脱患者脊柱-骨盆矢状位参数及小关节的研究

摘要

目的:探讨退变性腰椎滑脱患者脊柱-骨盆矢状位参数和腰椎小关节的特点,分析退变性滑脱的发生发展机制.方法:从2014年1月份到2015年12月份,于我科收集L4-5节段退变性腰椎滑脱的患者,作为DS组,共46例患者.根据年龄和性别匹配原则,纳入46例L4-5节段椎管狭窄的患者,作为DSS组.通过影像学资料测量评估两组病例的如下参数:PI、PT、SS、LL、TK、SVA、小关节方向、小关节不对称性、小关节退变分级和滑脱程度.比较两组患者参数的差异.对退变性腰椎滑脱患者小关节方向与其他参数进行相关性分析,并根据小关节方向不同将滑脱患者,分为小关节矢状化程度重的A组和矢状化轻度相对较轻的B组.对比分析两组病例相关参数的差异.结果:DS组小关节退变分级高于DSS组(P=0.045).DS组PI和PT大于DSS组(P＜0.001),小关节角度小于DSS组(P=0.004),两组小关节不对称程度没有统计学差异(P=0.483).DS组小关节方向与PI、LL、PT、滑脱程度和小关节退变程度呈现显著负相关(P＜0.05).A组小关节退变分级高于B组(P=0.037),PI、PT和滑脱程度均显著大于B组(P＜0.05).结论:退变性腰椎滑脱患者小关节矢状化程度和退变较重,PI较大,大PI和小关节矢状化是退变性腰椎滑脱发生发展的重要因素.%Objective:To explore the characteristics of spine-pelvic sagittal parameters and lumbar facet joint in patients with degenerative lumbar spondylolisthesis,and to analyze the development and progression of degenerative spondylolisthesis.Methods:We collected LA-5 segment degenerative lumbar spondylolisthesis patients as DS group with 46 cases from January 2014 to December 2015.According to the principle of age and gender matching,46 patients with L4-5 segmental spinal stenosis were included as DSS group.The following parameters were evaluated by imaging data:PI,PT,SS,LL,TK,SVA,facet joint orientation,facet joint asymmetry,degeneration grade of facet joint and slip degree.The differences of parameters between the two groups were analyzed.For the patients with degenerative lumbar spondylolisthesis,the relationship between the orientation of the facet joint and other parameters was analyzed.According to different facet joint orientation,patients with degenerative lumbar spondylolisthesis were divided into group A with more sagittal facet joint orientation and group B with relatively mild sagittal facet joint orientation.Differences of related parameters between the two groups were evaluated.Results:The degeneration grade of facet joint in DS group was higher than that in DSS group(P=0.045).PI and PT of DS group were higher than those of DSS group (P＜0.001).The facet joint orientation was less than that of DSS group (P=0.004).There was no significant difference in the facet joint asymmetry between the two groups (P=0.483).There was a significant negative correlation between facet joint orientation and PI,LL,PT,spondylolisthesis degree and degeneration degree of facet joint in DS group(P＜0.05).The severity of facet joint degeneration in group A was higher than that in group B(P=0.037).PI,PT and spondylolisthesis degree were significantly higher in group A than in group B(P＜0.05).Conclusions:The sagittal and degeneration degree of facet joint are heavy in patients with degenerative lumbar spondylolisthesis.Large PI and sagittal facet joint orientation are important factors in the development of degenerative lumbar spondylolisthesis.