退行性腰椎后滑脱的节段分布及与腰骶部矢状位平衡参数的关系

目的 探索腰椎后滑脱节段分布及与腰骶部矢状位平衡参数的相关性，揭示腰椎后滑脱发生机制。方法 选取2016年9月—2019年6月海军军医大学附属长征医院收治的腰椎后滑脱患者47例，调查其腰椎后滑脱节段分布规律，并将其分为上腰椎后滑脱组（L_1~3，34例）与下腰椎后滑脱组（L_4~5，13例）；选取同期入院的近似健康的患者29例作为对照组。比较3组患者腰椎前凸角（LL）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、骨盆入射角（PI）的差异。结果 47例患者共56个节段后滑脱，其中L₁ 5例、L₂ 13例、L₃ 25例、L₄ 11例、L₅ 2例。与对照组相比，上腰椎后滑脱组LL、SS增大，PT减小，差异有统计学意义（P<0.05），PI差异无统计学意义（P>0.05）；下腰椎后滑脱组LL、SS减小，PT增大，差异有统计学意义（P<0.05），PI差异无统计学意义（P>0.05）。结论 腰椎后滑脱好发于L₃，其次为L₂、L₄。腰椎后滑脱与腰骶部矢状位失衡密切相关。当上腰椎后滑脱时，LL、SS增大，而PT减小；当下腰椎后滑脱时，LL、SS减小，甚至变为后凸，而PT增大。

Segmental distribution of degenerative lumbar posterior spondylolisthesis and relationship with sagittal balance parameters in lumbosacral region

Objective To explore the distribution of lumbar posterior spondylolisthesis and the correlation with sagittal balance parameters in lumbosacral region for revealing the mechanism of lumbar posterior spondylolisthesis. Methods A total of 47 patients with lumbar posterior spondylolisthesis treated in Changzheng Hospital affiliated to Navy Medical University from September 2016 to June 2019 were selected to investigate the distribution pattern,and they were divided into upper lumbar posterior spondylolisthesis group(L_1-3,34 cases) and lower lumbar posterior spondylolisthesis group(L_4-5,14 cases). And 29 people close to health admitted in the same period were selected as the control group. The differences between the 3 groups were compared in terms of lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI). Results There were 56 spondylolisthesis segments in 47 patients,including 5 cases in L₁,13 in L₂,25 in L₃,11 in L₄,and 2 in L₅. Compared with the control group,the LL and SS increased significantly and the PT decreased significantly in upper lumbar posterior spondylolisthesis group,all with a statistical significance(P<0.05),and the difference in PI was not statistically significant(P>0.05);the LL and SS decreased significantly and the PT increased significantly in lower posterior lumbar spondylolisthesis group,all with a statistical significance(P<0.05),and the difference in PI was not statistically significant(P>0.05). Conclusion Lumbar posterior spondylolisthesis usually occurs in L₃,followed by L₂ and L₄. Lumbar posterior spondylolisthesis is closely related to the sagittal imbalance of the lumbosacral vertebra. When the upper lumbar posterior spondylolisthesis occurs,the LL and SS tend to become larger and the PT decreases. What is more,when the lower lumbar posterior spondylolisthesis occurs,LL tends to decrease,or even develop into local kyphosis,and the PT tends to increase.