CAJ | 학술논문

目的探讨重度腰椎滑脱脊柱-骨盆参数改变与临床症状的关系.方法回顾分析2006至2012年45例L5重度峡部裂滑脱患者全脊柱正侧位片资料,测量以下骨盆-脊柱参数值:滑脱百分比、PI、PT、SS、LL、TK、SFHD、SFVD、SC7D、T9倾斜角.对患者进行系统的腰痛评分,根据Oswestry评分的差异,将患者分成重度腰痛组和轻度腰痛组.组间T-检验比较两组患者各参数的差异；多因数相关分析,多元线性回归分析和逐步回归分析各参数与Oswestry评分的联系.结果重度腰痛组比轻度腰痛组:滑脱百分比、PT、LL、T9 t angle、SFHD、SC7D显著增大(均P＜0.05),SS和SFVD显著减小(均P＜0.05),PI、TK差异无统计学意义[(0.7 ±0.1)比(1.8±0.4)](P＞0.05).PT/SS、SFHD/SFVD、LL/TK 3对参数比值均显著增大(P＜0.05).线性回归及逐步回归分析显示,滑脱百分比、LL、SC7D、PT、SFHD与Oswestry显著正相关,正相关程度:滑脱百分比＞SC7D＞PT＞ LL＞SFHD; SS、SFVD与Oswestry显著负相关,负相关程度:SS＞ SFVD;PI、TK、T9偏移角与Oswestry无显著相关；PT/SS、SFHD/SFVD、LL/TK与Oswestry显著正相关；正相关程度:PT/SS＞ SFHD/SFVD＞ LL/TK.结论重度腰椎滑脱临床症状与滑脱百分比,LL、SC7D、PT、SFHD的大小呈显著正相关,与SS、SFVD显著负相关,与TK、PI、T9倾斜角大小无显著相关,与PT/SS、SFHD/SFVD、LL/TK3组参数的比值呈显著正相关.
목적 탐토중도요추활탈척주-골분삼수개변여림상증상적관계.방법 회고분석2006지2012년45례L5중도협부렬활탈환자전척주정측위편자료,측량이하골분-척주삼수치:활탈백분비、PI、PT、SS、LL、TK、SFHD、SFVD、SC7D、T9경사각.대환자진행계통적요통평분,근거Oswestry평분적차이,장환자분성중도요통조화경도요통조.조간T-검험비교량조환자각삼수적차이；다인수상관분석,다원선성회귀분석화축보회귀분석각삼수여Oswestry평분적련계.결과 중도요통조비경도요통조:활탈백분비、PT、LL、T9 t angle、SFHD、SC7D현저증대(균P＜0.05),SS화SFVD현저감소(균P＜0.05),PI、TK차이무통계학의의[(0.7 ±0.1)비(1.8±0.4)](P＞0.05).PT/SS、SFHD/SFVD、LL/TK 3대삼수비치균현저증대(P＜0.05).선성회귀급축보회귀분석현시,활탈백분비、LL、SC7D、PT、SFHD여Oswestry현저정상관,정상관정도:활탈백분비＞SC7D＞PT＞ LL＞SFHD; SS、SFVD여Oswestry현저부상관,부상관정도:SS＞ SFVD;PI、TK、T9편이각여Oswestry무현저상관；PT/SS、SFHD/SFVD、LL/TK여Oswestry현저정상관；정상관정도:PT/SS＞ SFHD/SFVD＞ LL/TK.결론 중도요추활탈림상증상여활탈백분비,LL、SC7D、PT、SFHD적대소정현저정상관,여SS、SFVD현저부상관,여TK、PI、T9경사각대소무현저상관,여PT/SS、SFHD/SFVD、LL/TK3조삼수적비치정현저정상관.
Objective To explore the relationship between variations of severe isthmic spondylolisthesis spinopelvic parameters and clinical symptoms.Methods A retrospective study of spinopelvic parameters was conducted for 45 patients with L5 severe isthmic spondylolisthesis.Their spinopelvic parameters were analyzed on preoperative full spinal radiography:grade of spondylolisthesis,pelvic incidence (PI),sacral slope (SS),pelvic tilt (PT),lumbar lordosis (LL),thoracic kyphosis (TK),SFHD,SFVD,SC7D and T9 tilting angle.According to the Oswestry score,the patients with low back pain were divided into light and severe groups.T-tests were used to compare their parameters.The analyses of multiple factor correlation,linear regression and stepwise regression were used to examine the associations between all parameters and Oswestry score.Results Grade of spondylolisthesis,PT,LL,T9 tilting angle,SFHD,SC7D,PT/SS,SFHD/SFVD,LL/TK were significantly greater and SS,SFVD were significantly smaller for patients with severe low back pain versus light low back pain (P ＜ 0.05).PI or TK had no statistically significant difference between two groups.Multiple factor correlation,linear regression and stepwise regression:Grade of spondylolisthesis,PT,SC7D,LL and SFHD had significant positive correlations with Oswestry score.Degree of positive correlation:Grade of spondylolisthesis ＞ SC7D ＞ PT ＞ LL ＞ SFHD.And PI,TK or T9 tilting angle had no significant correlation with Oswestry score.SS and SFVD had significant negative correlations with Oswestry score.Degree of negative correlation:SS ＞ SFVD.PT/SS,SFHD/SFVD and LL/TK had significant positive correlation with Oswestry score.Degree of positive correlation:PT/SS ＞ SFHD/SFVD ＞ LL/TK.Conclusion Clinical symptoms of severe isthmic spondylolisthesis have significant positive correlations with grade of spondylolisthesis,PT,SC7D,LL,SFHD,PT/SS,SFHD/SFVD,LL/TK and significant negative correlations with SS and SFVD.Low back pain symptom has no significant correlation with PI,TK or T9 tilting angle.