CAJ | 학술논문

目的探讨第4腰椎(L4)退变性滑脱(DLS)与影像学参数的关系.方法选取2010年4月至2012年4月收治的L4 DLS患者60例作为DLS组,同期年龄与性别相匹配的健康者56例作为对照组.两组研究对象均行腰椎正侧位X线、CT、MRI及骨密度检查.X线上测量椎间盘高度、L4椎体大小、L4椎体倾角、腰椎前凸角及骨盆投射角.CT上测量L3-4、L4-5头尾侧关节突关节角、关节突关节头尾差角及关节突不对称度.MRI上评估椎间盘退变指数.双能X线吸收法测定骨密度.采用t检验比较两组间各指标的差异,应用Logistic逐步回归分析退变性腰椎滑脱的危险因素.结果 DLS组Ⅰ度滑脱53例,Ⅱ度滑脱7例.滑脱指数为0.17±0.05.两组间椎间盘高度、椎间盘退变指数、L4椎体大小、L4椎体倾角、腰椎前凸角、骨盆投射角、关节突关节角、骨密度差异均有统计学意义(t=2.28 ～9.33,P=0.021 ～0.043);DLS组L3-4节段与L4-5节段关节突关节头尾差角与对照组同节段相比差异有统计学意义(t=3.398和28.122,P=0.000和0.039).而上述节段的关节突关节不对称度与对照组相比差异无统计学意义(t =0.209～ 0.465,P=0.295 ～0.858).Logistic回归分析显示:L4椎体大小(OR=1.01,95％CI=1.000 ～1.024,P=0.048)、L4椎体倾角(OR=1.88,95％CI=14.000 ～ 14.600,P=0.037)、腰椎前凸角(OR=1.90,95％ CI=1.600 ～ 15.800,P=0.040)、骨盆投射角(OR =2.58,95％CI=18.000～ 19.600,P=0.029)及关节突关节角(OR=2.46,95％ CI=1.400～16.400,P=0.035)是L4 DLS的危险因素.结论 DLS组患者具有更小的L4椎体,更大的L4倾角、腰椎前凸角、骨盆投射角及偏向矢状位的关节突关节角,这些可能是DLS的危险因素.
목적 탐토제4요추(L4)퇴변성활탈(DLS)여영상학삼수적관계.방법 선취2010년4월지2012년4월수치적L4 DLS환자60례작위DLS조,동기년령여성별상필배적건강자56례작위대조조.량조연구대상균행요추정측위X선、CT、MRI급골밀도검사.X선상측량추간반고도、L4추체대소、L4추체경각、요추전철각급골분투사각.CT상측량L3-4、L4-5두미측관절돌관절각、관절돌관절두미차각급관절돌불대칭도.MRI상평고추간반퇴변지수.쌍능X선흡수법측정골밀도.채용t검험비교량조간각지표적차이,응용Logistic축보회귀분석퇴변성요추활탈적위험인소.결과 DLS조Ⅰ도활탈53례,Ⅱ도활탈7례.활탈지수위0.17±0.05.량조간추간반고도、추간반퇴변지수、L4추체대소、L4추체경각、요추전철각、골분투사각、관절돌관절각、골밀도차이균유통계학의의(t=2.28 ～9.33,P=0.021 ～0.043);DLS조L3-4절단여L4-5절단관절돌관절두미차각여대조조동절단상비차이유통계학의의(t=3.398화28.122,P=0.000화0.039).이상술절단적관절돌관절불대칭도여대조조상비차이무통계학의의(t =0.209～ 0.465,P=0.295 ～0.858).Logistic회귀분석현시:L4추체대소(OR=1.01,95％CI=1.000 ～1.024,P=0.048)、L4추체경각(OR=1.88,95％CI=14.000 ～ 14.600,P=0.037)、요추전철각(OR=1.90,95％ CI=1.600 ～ 15.800,P=0.040)、골분투사각(OR =2.58,95％CI=18.000～ 19.600,P=0.029)급관절돌관절각(OR=2.46,95％ CI=1.400～16.400,P=0.035)시L4 DLS적위험인소.결론 DLS조환자구유경소적L4추체,경대적L4경각、요추전철각、골분투사각급편향시상위적관절돌관절각,저사가능시DLS적위험인소.
Objective To investigate the relationship between radiographic parameters and the 4th lumbar(L4) degenerative spondylolisthesis.Methods From April 2010 to April 2012,60 patients with the L4 degenerative spondylolisthesis (DLS) were enrolled in DLS group,56 healthy volunteers were recruited in control group.A series of radiographic parameters were measured in the two groups,including disc height (DH),disc degeneration index (DDI),L4 vertebral inclination angle (L4-VA),pelvic incidence (PI),L4 vertebral size (L4-VS),lumbar lordosis angle (LLA),facet joint angulation (FJA) of cephalad and caudad portions,delta FJA of cephlad and caudad portions,asymmetry variation of FJA,bone mineral density (BMD).Student's test was used to compare difference of parameters between two groups.Multivariate logistic regression analysis was used to reveal risk factors of the development of DLS.Results Fifty-three cases of L4 spondylolisthesis in DLS group were classified into grade I,7 cases of L4 spondylolisthesis were classified into grade Ⅱ.The average Boxall index was 0.17 ± 0.05.There were significant difference of DH,DDI,L4-VS,L4-VA,LLA,PI,FJA,BMD between DLS group and control group (t =2.28-9.33,P =0.021-0.043).There were significant differences of delta FJA of cephlad and caudad portions in L3-4,L4-5 between DLS group and control group (t =3.398 and 28.122,P =0.000 and 0.039).There was no significant difference of asymmetry variation of FJA in L3-4,L4-5 between DIS group and control group (t =0.209-0.465,P =0.295-0.858).Multivariate logistic regression analysis showed that LDS was more frequent among patients with smaller L4-VS(OR =1.01,95％ CI =1.000-1.024,P =0.048),larger L4-VA (OR =1.88,95％ CI =14.000-14.600,P =0.037),larger LLA (OR =1.90,95％ CI =1.600-15.800,P =0.040),larger PI (OR =2.58,95％ CI =18.000-19.600,P =0.029) and the more sagittal FJA (OR =2.46,95％ CI =1.400-16.400,P =0.035) than those in control group.Conclusions DLS is signifantly correlated with L4-VS,L4-VA,LLA,PI,FJA.They may be risk factors of the development of DLS.