CAJ | 학술논문

目的：观察成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数的变化，探讨L5入射角与腰椎滑脱程度的相关性。方法：回顾性分析60例L5/S1峡部裂性滑脱患者，年龄28~69岁（平均47.0岁）；以77例年龄（25~63岁，平均43.5岁）匹配的正常成人为对照组。在站立位全脊柱侧位X线片上测量L5滑移距离（slip distance， SD）、L5滑移百分比（slipping percentage，SP）以及骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt， PT）、骶骨倾斜角（sacral slope，SS）、L5入射角（L5 incidence，L5I）、腰骶角（lumbar-sacral angle，LSA）、腰椎前凸角（lumbar lordosis，LL）、矢状面平衡（sagittal vertical axis，SVA）等脊柱-骨盆矢状面参数。根据滑移百分比将滑脱组患者分成两组：轻度滑移组（A组，SP≤30%），30例；重度滑移组（B组，SP>30%），30例。采用独立样本t检验比较滑脱组与对照组及滑脱组内A、B组之间的差异，并用Pearson相关性分析对滑脱患者脊柱-骨盆参数与滑脱程度（SP）进行相关性分析。结果：滑脱组PI、PT、SS、LL均显著大于正常对照组，LSA显著小于对照组（P<0.05）。A组L5I与对照组相比无显著差异，B组L5I显著大于对照组（P<0.05）。B组PI、PT、SS、L5I显著大于A组，LSA显著小于A组（P<0.05）。滑脱组滑移百分比与PI、PT、SS、SVA均呈正相关，与LSA呈负相关（P<0.05）。A组滑移百分比与L5I未见显著相关性；B组L5I和SVA与滑移百分比呈显著性正相关（P<0.05）。滑脱组L5I与PI呈正相关，与LSA呈负相关。结论：成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数与正常人相比PI、PT、SS、LL均较大。滑移百分比大于30%患者的L5I明显增大，并与滑脱程度显著性相关，治疗时应重视对L5I的恢复重建。
목적：관찰성인협부렬성요추활탈환자척주-골분시상면삼수적변화，탐토L5입사각여요추활탈정도적상관성。방법：회고성분석60례L5/S1협부렬성활탈환자，년령28~69세（평균47.0세）；이77례년령（25~63세，평균43.5세）필배적정상성인위대조조。재참립위전척주측위X선편상측량L5활이거리（slip distance， SD）、L5활이백분비（slipping percentage，SP）이급골분입사각（pelvic incidence，PI）、골분경사각（pelvic tilt， PT）、저골경사각（sacral slope，SS）、L5입사각（L5 incidence，L5I）、요저각（lumbar-sacral angle，LSA）、요추전철각（lumbar lordosis，LL）、시상면평형（sagittal vertical axis，SVA）등척주-골분시상면삼수。근거활이백분비장활탈조환자분성량조：경도활이조（A조，SP≤30%），30례；중도활이조（B조，SP>30%），30례。채용독립양본t검험비교활탈조여대조조급활탈조내A、B조지간적차이，병용Pearson상관성분석대활탈환자척주-골분삼수여활탈정도（SP）진행상관성분석。결과：활탈조PI、PT、SS、LL균현저대우정상대조조，LSA현저소우대조조（P<0.05）。A조L5I여대조조상비무현저차이，B조L5I현저대우대조조（P<0.05）。B조PI、PT、SS、L5I현저대우A조，LSA현저소우A조（P<0.05）。활탈조활이백분비여PI、PT、SS、SVA균정정상관，여LSA정부상관（P<0.05）。A조활이백분비여L5I미견현저상관성；B조L5I화SVA여활이백분비정현저성정상관（P<0.05）。활탈조L5I여PI정정상관，여LSA정부상관。결론：성인협부렬성요추활탈환자척주-골분시상면삼수여정상인상비PI、PT、SS、LL균교대。활이백분비대우30%환자적L5I명현증대，병여활탈정도현저성상관，치료시응중시대L5I적회복중건。
Objectives: To investigate the differences of spino-pelvic parameters in patients with isthmic spondylolisthesis of different grades, and the correlation between L5 incidence angle (L5I) and the percentage of spondylolisthesis. Methods: 60 patients with L5-S1 isthmic spondylolisthesis(mean age, 47.0 years; range, 28 to 69 years) and age-matched control group of 77 normal adults(mean age, 43.5 years; range, 25 to 63 years) were recruited in this retrospective study. Parameters including slip distance (SD), slipping percentage (SP), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), L5 incidence(L5I), lumbar-sacral angle(LSA), lumbar lordosis(LL), sagittal vertical axis(SVA) were measured on the long-cassette standing upright lateral radiographs of the spine and pelvis. Patients with spondylolisthesis were divided into two groups based on slipping per-centage: group A(low grade) with SP≤30%(30 cases of 60) and group B(high grade) with SP>30%(30 cases of 60). Differences in sagittal parameters among groups were analyzed by using independent samples t-test, and Pearsons′ correlation coefficients were used to investigate the relationship between spino-pelvic parameters and SP. Results: PI, PT, SS, and LL were higher(P<0.05) in subjects with isthmic spondylolisthesis than those in the control group, while LSA decreased significantly. L5I in group B was significantly higher than that in control group, while there was no significant difference between group A and control group. Strong positive correlation between SP and PI, PT, SS, SVA and negative correlation between SP and LSA were confirmed in all the patients with spondylolisthesis. SP showed a positive correlation with L5I in group B(P<0.05), which was the other case in group A. L5I demonstrated a positive correlation with PI and showed a negative rela-tion to LSA in the total isthmic spondylolisthesis group. Conclusions: Spino-pelvic parameters including PI, PT, SS and LL are significantly greater in adult patients with isthmic spondylolisthesis. L5I significantly in-creases in patients with severer spondylolisthesis and shows positive correlation with slipping percentage which indicates that more attention should be paid to the improvement of L5I.