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-  2015 

下腰椎小关节退变与脊柱-骨盆矢状面平衡的相关性研究

DOI: doi:10.7507/1002-1892.20150208

Keywords: 脊柱-骨盆矢状面平衡, 小关节退变, 腰椎, 骨盆入射角

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Abstract:

目的探讨下腰椎各节段椎小关节退变程度与脊柱-骨盆矢状面各平衡参数间的关系。 方法回顾性分析2014年6月-11月符合选择标准的120例腰椎退行性疾病患者临床资料,其中男58例,女62例;年龄24~77岁,平均53岁。病程3~96个月,平均6.6个月。病变节段:L3、4 32例,L4、5 47例,L5、S1 52例。患者均摄腰椎CT及站立位腰椎侧位X线片,依据Pathria分级系统对下腰椎小关节退变程度进行分级,并测量以下矢状面参数:脊柱参数——腰椎前凸角(lumbar lordosis,LL)、上腰弯前凸角(upper lumbar lordosis,ULL)、下腰弯前凸角(lower lumbar lordosis,LLL)和骨盆参数——骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)。将所有患者按PI测量值分为小于正常范围组(A组)、正常范围组(B组)和大于正常范围组(C组),分节段比较各组小关节退变程度;同时,将所有患者分节段依据小关节退变程度分为轻度退变(0、Ⅰ级)组(N组)及重度退变(Ⅱ、Ⅲ级)组(M组),比较矢状面参数与各节段小关节退变之间的关系。 结果在L4、5和L5、S1节段,A、B、C组间小关节退变程度比较差异均有统计学意义(P<0.05),C组小关节退变更严重;但在L3、4节段,各组间小关节退变程度比较差异无统计学意义(P>0.05)。各节段N、M组间除PT比较差异有统计学意义(P<0.05)外,其余各脊柱-骨盆矢状面参数两组间比较差异均无统计学意义(P>0.05)。 结论大于正常范围的PI可导致或加重L4、5及L5、S1节段小关节的退变;PT及PI与下腰椎小关节退变程度显著相关

References

[1]  1. Barrey C,Jund J,Noseda O,et al.Sagittal balance of the pelvisspine complex and lumbar degenerative diseases.A comparative study about 85 cases.Eur Spine J,2007,16(9):1459-1467.
[2]  2. Kirkaldy-Willis WH,Farfan FH.Instability of the lumbar spine.Clin Orthop Relat Res,1982,(165):110-123.
[3]  3. 刘辉,希腊本大,郑召民,等.腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性.中华医学杂志,2013,93(15):1123-1128.
[4]  4. Pathria M,Sartoris DJ,Resnick D.Osteoarthritis of the facet joints:accuracy of oblique radiographic assessment.Radiology,1987,164(1):227-230.
[5]  5. 李危石,孙卓然,陈仲强.正常脊柱-骨盆矢状位参数的影像学研究.中华骨科杂志,2013,33(5):447-453.
[6]  6. Newman PH.Spondylolisthesis,its cause and effect.Ann R Coll Surg Engl,1955,16(5):305-323.
[7]  8. Boden SD,Riew KD,Yamaguchi K,et al.Orientation of the lumbar facet joints:association with degenerative disc disease.J Bone Joint Surg (Am),1996,78(3):403-411.
[8]  10. Barrey C,Roussouly P,Perrin G,et al.Sagittal balance disorders in severe degenerative spine.Can we identify the compensatory mechanisms? Eur Spine J,2011,20 Suppl 5:626-633.
[9]  11. Roussouly P,Nnadi C.Sagittal plane deformity:an overview of interpretation and management.Eur Spine J,2011,19(11):1824-1836.
[10]  13. Boulay C,Tardieu C,Hecquet J,et al.Sagittal alignment of spine and pelvis regulated by pelvic incidence:standard values and prediction of lordosis.Eur Spine J,2006,15(4):415-422.
[11]  23. Dunlop RB,Adams MA,Hutton WC.Disc space narrowing and the lumbar facet joints.J Bone Joint Surg (Br),1984,66(5):706-710.
[12]  24. Haher TR,O'Brien M,Dryer JW,et al.The role of the lumbar facet joints in spinal stability.Identification of alternative paths of loading.Spine (Phila Pa 1976),1994,19(23):2667-2670.
[13]  25. Schwarzer AC,Wang SC,Bogduk N,et al.Prevalence and clinical features of lumbar zygapphysial joint pain:a study in Australian population with chronic low back.Ann Rheum Dis,1995,54(2):100-106.
[14]  7. Robertson PA,Grobler LJ,Novotny JE,et al.Postoperative spondylolisthesis at L4-5.The role of facet joint morphology.Spine (Phila Pa 1976),1993,18(11):1483-1490.
[15]  9. Tanno I,Murakami G,Oguma H,et al.Morphometry of the lumbar zygapophyseal facet cap sule and cartilage with special reference to degenerative osteoarthritic changes:an anatomical study using fresh cadavers of elderly Japanese and Korean subjects.J Orthop Sci,2004,9(5):468-477.
[16]  12. Legaye J,Duval-Beaupère G.Sagittal plane alignment of the spine and gravity:a radiological and clinical evaluation.Acta Orthop Belg,2005,71(2):213-220.
[17]  14. Mangione P,Gomez D,Senegas J.Study of the course of the incidence angle during growth.Eur Spine J,1997,6(3):163-167.
[18]  15. Jentzsch T,Geiger J,Bouaicha S,et al.Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine.BMC Med Imaging,2013,13:34.
[19]  16. Jentzsch T,Geiger J,K?nig MA,et al.Hyperlordosis is associated with facet joint pathology at the lower lumbar spine.J Spinal Disord Tech,2013.[Epub ahead of print].
[20]  17. 郭世绂.临床骨科解剖学.天津:天津科技出版社,1984:185-212.
[21]  18. 赵耀,李淳德,孙浩林.脊柱矢状位平衡的影像学参数及分型的研究进展.中国脊柱脊髓杂志,2012,22(7):651-655.
[22]  19. Peleg S,Dar G,Steinberg N,et al.Sacral orientation and spondylolysis.Spine (Phila Pa 1976),2009,34(25):E906-910.
[23]  20. Natarajan RN,Lavender SA,An HA,et al.Biomechanical response of a lumbar intervertebral disc to manual lifting activities:a poroelastic finite element model study.Spine (Phila Pa 1976),2008,33(18):1958-1965.
[24]  21. Nagaosa Y,Kikuchi S,Hasue M,et al.Pathoanatomic mechanisms of degenerative spondylolisthesis:a radiographic study.Spine (Phila Pa 1976),1998,23(13):1447-1451.
[25]  22. Margulies JY,Payzer A,Nyska M,et al.The relationship between degenerative changes and osteoporosis in the lumbar spine.Clin Orthop Relat Res,1996,(324):145-152.
[26]  26. van Schaik JP.Lumbar facet joint morphology.Spinal Disord,2000,13(1):88-89.
[27]  27. Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a quantitative radiographic and clinical analysis.Spine (Phila Pa 1976),2002,27(4):387-392.

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