摘要
目的比较L_4退行性滑脱和L_4/L_5椎间盘突出症患者骨性参数的差异,分析L_4退行性滑脱发生的危险因素。方法回顾性分析21例L_4退行性滑脱(A组)及18例L_4/L_5椎间盘突出症患者(B组)的病例资料。通过测量腰椎矢状位X线片、45°双斜位X线片及CT获得骨性参数,矢状位X线片参数包括Taillard指数、腰椎指数(LI)、矢状面旋转度(SR)、骶骨水平角(SS)、腰椎前凸角(LL)、腰椎双凹指数(DCI)、L_4/L_5椎间盘角(IDA)、L_4/L_5椎间盘指数(DI)、腰椎重力线指数(LGLI);45°双斜位X线片参数包括L_4椎体高度(h)、L_4小关节倾斜角(α)、L3下关节突至L_4峡部距离(d)、L_5上关节突至L_4峡部距离(e)、L_4峡部宽度(k);CT参数为L_4小关节角(θ);比较2组各参数的差异,并分析各参数间的相关性。基于MRI图像,应用Pfirrmann椎间盘退行性变分级系统对2组患者L_4/L_5椎间盘进行分级,比较2组椎间盘退行性变分级的差异。结果 A组患者LI、IDA、DI、d、e、θ均明显小于B组,而LGLI、α以及L_4/L5椎间盘退行性变程度均明显大于B组,差异均有统计学意义(P <0.05)。相关性分析显示Taillard指数与LI、θ呈负相关,与LGLI呈正相关。结论椎间盘退行性变、α增大、LGLI增大、θ减小、LI减小、IDA减小、DI减小、关节突至峡部距离减小可能是L_4退行性滑脱发生的危险因素。
Objective To compare the differences of bone parameters between L4 degenerative spondylolisthesis and L4/L5 disc herniation and analyze the risk factors of L4 degenerative spondylolisthesis.Methods The clinical data of 21 patients with L4 degenerative spondylollisthesis(group A)and 18 with L4/L5 disc herniation(group B)were collected in the study.The parameters on sagittal roentgenographs included Taillard index,lumbar index(LI),sagittal rotation(SR),sacral slope(SS),lumbar lordosis(LL)angle,double concave index(DCI),intervertebral disc angle(IDA),disc index(DI)and lumbar gravity line index(LGLI);the parameters on 45°oblique roentgenographs included the height of L4 vertebral body(h),the distance from the L3 inferior articular process to the L4 isthmus(d),the distance from the L5 superior articular process to the L4 isthmus(e),the width of L4 isthmus(k),facet inclination angle(α);and L4 facet angle(θ)on CT.The differences of the parameters between 2 groups were compared,and the relationship of the parameters was analyzed.The degeneration of the L4/L5 disc was graded by Pfirrmann grading system according to MRI,and the difference between the 2 groups was compared.Results LI,IDA,DI,d,e,andθwere smaller in group A than in group B;LGLI,α,and the degeneration of the disc were greater in group A than in group B;the differences were statistically significant(P<0.05).The Taillard index was negatively correlated with LI andθ,and positively correlated with LGLI.Conclusion Degeneration of intervertebral disc,greaterα,greater LGLI,smallerθ,smaller LI,smaller IDA,smaller DI and smaller distance from articular process to the L4 isthmus may be the risk factors for L4 degenerative spondylolisthesis.
作者
王虎虎
张军武
WANG Hu-hu;ZHANG Jun-wu(Secondary Department of Orthopaedics,Yulin No.2 Hospital,Yulin 719000,Shaanxi,China)
出处
《脊柱外科杂志》
2019年第1期42-46,共5页
Journal of Spinal Surgery
关键词
腰椎
脊椎滑脱
放射摄影影像解释
计算机辅助
Lumbar vertebrae
Spondylolysis
Radiographic image interpretation,computer-assisted
