腰椎峡部裂性滑脱及退行性滑脱与正常腰椎椎弓根形态学参数比较

关键词：腰椎  脊椎滑脱  摄影测量法

Keywords:Lumbar vertebrae  Spondylolysis  Photogrammetry

摘要：

      目的 比较腰椎峡部裂性滑脱及退行性滑脱与正常腰椎椎弓根的形态学参数，探究其与滑脱发生、发展的关系。方法 2022年1月—2025年4月，收治L₅滑脱患者110例，其中L₅峡部裂性滑脱70例（峡部裂组），L₅退行性滑脱40例（退行组），并选取30名同时期健康志愿者作为对照组。在腰椎CT平扫及三维重建图像上测量并比较椎弓根形态学参数：椎弓根内聚角（PCA）、椎弓根宽度（PW）、椎弓根长度（PL）及钉道长度（STL）。结果 与退行组相比，峡部裂组L_4，5的PCA和PL增大、PW减小，差异均有统计学意义（P<0.05）；2组STL差异无统计学意义（P>0.05）。与对照组相比，峡部裂组L₄的PCA增大、PW减小，L₅的PCA和PL增大、PW减小，差异均有统计学意义（P<0.05）；2组STL差异无统计学意义（P>0.05）。进一步比较峡部裂组L_4，5两侧椎弓根形态学参数，L_4，5两侧PW、PL和STL差异均有统计学意义（P<0.05），两侧PCA差异无统计学意义（P>0.05）。结论 峡部裂性滑脱患者存在L₅ PCA和PL增大、PW减小等形态学变化，这可能是一种原发性改变而非继发于滑脱后的力学重塑。

Abstract:

      Objective To compare the lumbar pedicle morphological parameters between spondylolytic spondylolisthesis and degenerative spondylolisthesis/normal lumbar vertebrae，and explore their relationship with the occurrence and progression of spondylolisthesis. Methods From January 2022 to April 2025，110 patients with L₅ spondylolisthesis were admitted，including 70 with L₅ spondylolytic spondylolisthesis（spondylolytic group） and 40 with L₅ degenerative spondylolisthesis（degenerative group）.Additionally，30 healthy volunteers from the same period were selected as the control group.The lumbar pedicle morphological parameters were measured and compared on the lumbar CT plain scan and 3D reconstruction images，including pedicle cohesion angle（PCA），pedicle width（PW），pedicle length（PL），and screw track length（STL）. Results Compared with the degenerative group，the PCA and PL of L_4，5 increased in the spondylolytic group，while the PW decreased，and the differences were statistically significant（P<0.05）； there was no statistically significant difference in STL between the 2 groups（P>0.05）.Compared with the control group，the PCA of L₄ increased and the PW decreased in the spondylolytic group，and the PCA and PL of L₅ increased and the PW decreased in the spondylolytic group，and the differences were statistically significant（P<0.05）； there was no statistically significant difference in STL between the 2 groups（P>0.05）.Further comparing the pedicles morphological parameters on both sides of L_4，5 in the spondylolytic group，the PW，PL and STL on both sides of L_4，5 had statistically significant differences（P<0.05），while the PCA had no statistically significant difference on both sides（P>0.05）. Conclusions Patients with spondylolytic spondylolisthesis have morphological changes such as increased PCA and PL and decreased PW at L₅，which may be a primary change rather than a secondary mechanical remodeling after spondylolisthesis.