摘要
目的探讨腰解剖学参数对腰椎峡部裂伴滑脱的发生、发展及术后复位的影响。方法分析2009年2月至2012年12月，我院经治的129例L5峡部裂滑脱患者的影像学资料，男69例，女60例，年龄27～73岁，平均48．9岁。测量L5椎体相对倾斜角、腰骶角、腰椎前凸角、关节突关节角、椎间隙相对高度、术前L5椎体滑移率及手术复位率等参数。同时选取与峡部裂滑脱组性别、体重、年龄条件相近的同期129例非腰椎峡部裂滑脱患者作为对照组。结果滑脱组L5椎体相对倾斜角（22．96±6．83）°，腰骶角（9．17±5．72）°，腰椎前凸角（22．77±9．89）°，左侧小关节突冠状面角度（50．19±5．03）°，右侧小关节突冠状面角度（51．91±6．34）°，两侧平均关节突关节冠状面角度（51．03±5．50）°，椎间隙相对高度（22．81±7．27）％。L5峡部裂滑脱组各参数与非峡部裂滑脱组比较，L5峡部裂滑脱组的腰骶角度较小（P〈0．01），关节突关节面更偏向于冠状面（P〈0．01），椎间隙相对高度明显较低（P〈0．01）；L，相对倾斜角与术前L5椎体滑脱率呈正相关（r=0．538，P〈0．01），L5～S1椎间隙相对高度与术前L5椎体滑脱率呈负相关（r=-0．705，P〈0．01）；L5-S1椎间隙相对高度与手术复位率呈正相关（r=0．682，P〈0．01），L5术前滑脱率与手术复位率呈负相关（r=-0．359，P〈0．011，左、右及平均关节突关节角与手术复位率呈负相关（r=-0．258，P〈0．01；r=-0．24，P〈0．01；r=-0．231．P〈0．01）。结论腰椎峡部裂伴滑脱的风险因素可能与腰骶角、关节突关节角、椎间隙相对高度有关；术前的滑脱程度（疾病进展）与L5相对倾斜角、椎间隙相对高度有关；术后复位率与椎间隙相对高度、术前滑脱率和左、右、平均关节突关节角有关。因此，不同的解剖学参数对峡部裂滑脱的发生、发展及术后复位率有不同的影响。
bjective To investigate the influence of anatomy parameters on the pathogenesis, progress and postoperative restoration of lumbar spondylolysis and spondylolisthesis. Methods From February 2009 to December 2012, 129 patients with L5 isthmic spondylolisthesis were admitted, whose imaging data were analyzed. There were 69 men and 60 women, with a mean age of 48.9 years old （ range; 27-73 years ）. The relative tilt angle of L5 vertebral body, lumbosacral angle, lumbar lordosis angle, angle of facet joints, relative height of intervertebral space, preoperative slippage rate of L5 vertebral body and surgical reduction rate were measured. In addition, 129 patients without lumbar isthmic spondylolisthesis were collected as the control group with the same sex, weight, and age condition during the same period. Results In the isthmic spondylolisthesis group, the relative tilt angle of L5 vertebral body was （ 22.96±6.83 ） °, the lumbosacral angle was （ 9.17±5.72 ） °, the lumbar lordosis angle was （ 22.77±9.89 ） °, the coronal plane angle of the left facet joints was （ 50.19±5.03 ） °, the coronal plane angle of the right facet joints was （ 51.91±6.34 ） °, the mean coronal plane angle in both sides of facet joints was （ 51.03±5.50 ） °, and the relative height of intervertebral space was （ 22.81 ±7.27 ） %. When compared with the parameters in the non-isthmic spondylolisthesis group, the lumbosacral angle was smaller （ P〈0.01 ）, the surface of facet joints was closer to the coronal plane （ P〈0.01 ）, and the relative height of intervertebral space was obviously decreased in the L5 isthmic spondylolisthesisgroup （ P〈0.01 ）. The relative tilt angle of L5 vertebral body and the preoperative slippage rate showed a positive correlation （ r=0.538, P〈0.01 ）. The relative height of L5- S1 intervertebral space and the preoperative slippage rate of L5 vertebral body was negatively correlated （ r=-0.705, P〈0.01 ）. The relative height of L5- S1 intervertebral space and the surgical reduction rate was positively correlated （ r=0.682, P〈0.01 ）. The preoperative slippage rate of L5 vertebral body and the surgical reduction rate was negatively correlated （ r=-0.359, P〈0.01 ）. The angle of the left and right facet joints and the average angle and the surgical reduction rate was negatively correlated （ r=-0.258, P〈0.01; r=-0.24, P〈0.01; r=-0.231, P〈0.01 ）. Conclusions The risk factors for lumbar spondylolysis and spondylolisthesis include the lumbosacral angle, angle of facet joints and relative height of intervertebral space. The preoperative slippage rate or disease progress is related to the relative tilt angle of L5 vertebral body and relative height of intervertebral space. The relative height of intervertebral space, preoperative slippage rate and angle of the left and right facet joints and the average angle can predict the postoperative recurrence rate. Therefore, different anatomy parameters have diverse clinical significance in the pathogenesis, progress and postoperative restoration rate of isthmie spondylolisthesis.
出处
《中国骨与关节杂志》
CAS
2013年第10期568-573,共6页
Chinese Journal of Bone and Joint
关键词
脊椎滑脱
解剖标志
影响因素分析
腰椎
Spondylolysis
Anatomic landmarks
Root cause analysis
Lumbar vertebrae
