发育不良性L5/S1腰椎滑脱患者脊柱-骨盆矢状面形态分析

关键词：腰椎  脊椎滑脱  骨盆测量  摄影测量法

Keywords:Lumbar vertebrae  Spondylolysis  Pelvimetry  Photogrammetry

摘要：

      目的 比较发育不良性L₅/S₁腰椎滑脱患者与正常人群的脊柱-骨盆矢状面形态学参数的差异。方法 回顾性分析2012年1月—2025年1月于绍兴市上虞人民医院就诊的30例发育不良性L₅/S₁腰椎滑脱患者临床和影像学资料（滑脱组），另选取同时期因腰背部疼痛就诊的60例资料匹配、影像学资料完整的非腰椎滑脱患者作为对照组。在站立位全脊柱侧位X线片上测量矢状面垂直轴（SVA）、胸椎后凸角（TK）、腰椎前凸角（LL）、腰骶前凸角（LSL）、骶骨倾斜（ST）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）等参数。并进一步比较滑脱组不同年龄亚组脊柱-骨盆矢状面参数的差异性。结果 滑脱组SVA、LSL、ST、PI、PT、SS明显高于对照组，而TK明显低于对照组，差异均有统计学意义（P<0.05），2组LL差异无统计学意义（P>0.05）。不同年龄亚组两两相比，组间SVA、TK、ST和PT差异均无统计学意义（P>0.05）；LL、LSL、PI和SS在> 20岁组呈现出增大趋势，但组间差异无统计学意义（P>0.05）。结论 与非腰椎滑脱患者相比，发育不良性腰椎滑脱患者早期即可以表现出躯干前倾，TK减小，LSL、ST、PI、PT、SS增大。

Abstract:

      Objective To compare the differences in spinopelvic sagittal morphological parameters between patients with dysplastic L₅/S₁ lumbar spondylolisthesis and normal individuals. Methods From January 2012 to January 2025， the clinical and imaging data of 30 patients with dysplastic L₅/S₁ lumbar spondylolisthesis（spondylolisthesis group） admitted to Shangyu People’s Hospital of Shaoxing were retrospectively analyzed. Additionally， 60 patients without lumbar spondylolisthesis with matching clinical data and complete imaging data during the same period who visited the hospital due to low back pain were selected as the control group. The spinopelvic sagittal parameters were measured on standard standing full-spine lateral roentgenographs， including sagittal vertical axis（SVA）， thoracic kyphosis（TK）， lumbar lordosis（LL）， lumbosacral lordosis（LSL）， sacral tilt（ST）， pelvic incidence（PI）， pelvic tilt（PT） and sacral slope（SS）. Furthermore， the differences in the spinopelvic sagittal morphological parameters between the different age subgroups of the spondylolisthesis group were compared. Results The SVA， LSL， ST， PI， PT， and SS in the spondylolisthesis group were significantly higher than those in the control group， while TK was significantly lower than that in the control group， and all the differences were statistically significant（P<0.05）. There was no statistically significant difference in LL between the 2 groups（P>0.05）. When comparing each age subgroup pair by pair， there were no statistically significant differences in SVA， TK， ST and PT between the groups（P>0.05）； however， LL， LSL， PI， and SS exhibited an increasing trend in the>20-year-old group， but the intergroup differences were not statistically significant（P>0.05）. Conclusions Compared with patients without lumbar spondylolisthesis， dysplastic lumbar spondylolisthesis patients exhibit forward trunk inclination， reduced TK， and increased LSL， ST， PI， PT and SS in the early stages.