退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析
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作者Author单位AddressE-Mail
周林杰 ZHOU Lin-jie 皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241001 Department of Traumatology and Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China  
杨民 YANG Min 皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241001 Department of Traumatology and Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China pkuyang@hotmail.com 
郑伟伟 ZHENG Wei-wei 皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241001 Department of Traumatology and Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China  
张俊宇 ZHANG Jun-yu 皖南医学院弋矶山医院创伤骨科, 安徽 芜湖 241001 Department of Traumatology and Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241001, Anhui, China  
期刊信息:《中国骨伤》2020年,第33卷,第9期,第862-866页
DOI:10.12200/j.issn.1003-0034.2020.09.014
基金项目:国家自然科学基金(编号:81341054,81171732);皖南医学院人才引进基金(编号:YR201411)
中文摘要:目的:分析退变性腰椎滑脱(degenerative lumbar spondylolisthesis,DLS)中腰椎-骨盆结构特点及其在退变性腰椎滑脱症中的意义。

方法:对2015年4月至2017年1月收治的45例单纯退行性L4,5节段腰椎滑脱患者(滑脱组)的临床资料进行回顾性分析,并与同期50例(对照组)体检资料齐全的健康者进行比较。通过影像学资料对受试者的腰椎-骨盆结构参数进行统计分析,分析DLS患者的脊柱-骨盆特点。观察退变性腰椎滑脱患者椎间盘及关节突关节退变特点。利用Spearson分析各观察项目之间的相关性。

结果:滑脱组L4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(36.5±11.2)°、(44.2±7.3)°、(66.5±11.6)°、(22.2±10.0)°、(33.4±11.3)°。对照组L4,5关节突关节角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角为(44.4 ±8.2)°、(36.7±8.5)°、(55.4±13.2)°、(14.4±7.0)°、(42.3±13.1)°,滑脱组骨盆入射角、腰椎前凸角、骨盆倾斜角明显大于对照组(P<0.05),而关节突关节角、骶骨倾斜角小于对照组(P<0.05)。两组骨盆入射角与骨盆倾斜角、骶骨倾斜角之间有相关性(P<0.05),椎间盘退变与关节突关节之间存在相关性(P<0.05)。滑脱组L3-S1椎间盘及L4,5关节突关节退变更加严重。

结论:腰椎-骨盆结构在退变性腰椎滑脱中发生了明显的变化。腰椎前凸及骨盆后倾现象在腰椎退变性滑脱身体代偿机制中有重要作用,腰椎关节突关节退变与腰椎间盘退变是相互促进的,腰椎滑脱加剧椎间盘与关节突关节退变。
【关键词】退变性腰椎滑脱  脊柱-骨盆平衡  椎间盘退行性变  关节突关节
 
Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis
ABSTRACT  Objective: To analyze the characteristics of lumbar spine-pelvic structure in degenerative lumbar spondylolisthesis and its significance in degenerative lumbar spondylolisthesis (DLS).

Methods: The clinical data of 45 patients with simple degenerative L4,5-segment lumbar spondylolisthesis (spondylolisthesis group) admitted from April 2015 to January 2017 were retrospectively analyzed,which were compared with 50 healthy people with complete physical examination data in the same period (control group). Statistical analysis of the lumbar spine-pelvic structure parameters of the subjects through imaging data was performed to analyze the characteristics of the spine-pelvis of DLS patients. The degenerative characteristics of intervertebral disc and articular process joint were observed in degenerative lumbar spondylolisthesis. Use Spearson to analyze the correlation between observation items.

Results: The facet joint angle,lumbar lordosis angle (LL),pelvic incidence angle (PI),pelvic tilt angle (PT),sacral slope angle (SS) in spondylolisthesis group of L4,5-segment were (36.5±11.2)°, (44.2±7.3)°, (66.5±11.6)°, (22.2±10.0)°, (33.4±11.3)°,respectively,while in control group were (44.4±8.2)°, (36.7±8.5)°, (55.4±13.2)°, (14.4±7.0)°, (42.3±13.1)°. PI,LL,PT of spondylolisthesis group were obviously larger than that of control group (P<0.05),the facet joint angle and SS of spondylolisthesis group were smaller than that of control group (P<0.05). The correlation analysis showed that PI value was related to the PT and SS in two group. The degree of degeneration of intervertebral disc was related to the degree of spondylolisthesis. The degree of degeneration of L3-S1 intervertebral disc and L4,5 facet joint in spondylolisthesis group was more serious (P<0.05).

Conclusion: Lumbar spinal-pelvic structure of degenerative lumbar spondylolisthesis has undergone significant changes. Lumbar lordosis and pelvic dumping phenomenon in the mechanism of lumbar degeneration plays an important role. Lumbar facet joint degeneration and lumbar intervertebral disc degeneration are mutually promoted,and lumbar spondylolisthesis aggravates intervertebral disc and facet joint degeneration.
KEY WORDS  Degenerative lumbar spondylolisthesis  Balance of Lumbar pelvis  Intervertebral disc degeneration  Facet joint
 
引用本文,请按以下格式著录参考文献:
中文格式:周林杰,杨民,郑伟伟,张俊宇.退变性腰椎滑脱中腰椎-骨盆结构参数的特点分析[J].中国骨伤,2020,33(9):862~866
英文格式:ZHOU Lin-jie,YANG Min,ZHENG Wei-wei,ZHANG Jun-yu.Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(9):862~866
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