CAJ | 학술논문

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)；L5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＜0.01)，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。
목적탐토요해부학삼수대요추협부렬반활탈적발생、발전급술후복위적영향。방법분석2009년2월지2012년12월，아원경치적129례L5협부렬활탈환자적영상학자료，남69례，녀60례，년령27～73세，평균48.9세。측량L5추체상대경사각、요저각、요추전철각、관절돌관절각、추간극상대고도、술전 L5추체활이솔급수술복위솔등삼수。동시선취여협부렬활탈조성별、체중、년령조건상근적동기129례비요추협부렬활탈환자작위대조조。결과활탈조L5추체상대경사각(22.96±6.83)°，요저각(9.17±5.72)°，요추전철각(22.77±9.89)°，좌측소관절돌관상면각도(50.19±5.03)°，우측소관절돌관상면각도(51.91±6.34)°，량측평균관절돌관절관상면각도(51.03±5.50)°，추간극상대고도(22.81±7.27)%。L5협부렬활탈조각삼수여비협부렬활탈조비교，L5협부렬활탈조적요저각도교소( P＜0.01)，관절돌관절면경편향우관상면( P＜0.01)，추간극상대고도명현교저( P＜0.01)；L5상대경사각여술전L5추체활탈솔정정상관( r＝0.538，P＜0.01)，L5～S1추간극상대고도여술전L5추체활탈솔정부상관( r＝-0.705，P＜0.01)；L5～S1추간극상대고도여수술복위솔정정상관( r＝0.682，P＜0.01)，L5술전활탈솔여수술복위솔정부상관( r＝-0.359， P＜0.01)，좌、우급평균관절돌관절각여수술복위솔정부상관( r＝-0.258，P＜0.01；r＝-0.24，P＜0.01；r＝-0.231，P＜0.01)。결론요추협부렬반활탈적풍험인소가능여요저각、관절돌관절각、추간극상대고도유관；술전적활탈정도(질병진전)여L5상대경사각、추간극상대고도유관；술후복위솔여추간극상대고도、술전활탈솔화좌、우、평균관절돌관절각유관。인차，불동적해부학삼수대협부렬활탈적발생、발전급술후복위솔유불동적영향。
Objective To investigate the inlfuence 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 spondylolisthesis <br> group ( 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 signiifcance in the pathogenesis, progress and postoperative restoration rate of isthmic spondylolisthesis.