标题：影像学参数对L4椎体发生退变性滑脱的影响

      作者：王永江
    (鄂尔多斯市中心医院脊柱外科，内蒙古 鄂尔多斯 017000)

      卷次： 2015年26卷12期

      【摘要】 目的 探讨影像学参数对第4腰椎(L4)退变性滑脱(DLS))的影响。方法 选取我院2012年5月至
2014年9月收治的L4椎体发生DLS的患者56例为DLS组，同期健康体检的志愿者56例为对照组。两组研究对
象均行腰椎正侧位X线片、CT及骨密度检查并测量相关影像学参数。采用Logistic逐步回归分折与退变性腰椎
滑脱的相关的影像学参数。结果 DLS组L4腰椎Ⅰ度滑脱49例，Ⅱ度滑脱7例；滑脱指数为(0.195±0.041)。与对
照组比较，DLS组椎间盘高度、L4椎体大小、椎体指数及骨密度均降低，差异均有统计学意义(P<0.05)；而DLS组
患者的L4椎体倾角、腰椎前凸角、骨盆投射角、腰骶角更大，差异均有统计学意义(P<0.05)。与对照组比较，DLS
组患者的关节突关节角更偏向矢状位，关节突关节不对称性显著，关节突关节椎弓根角更偏向水平位，差异均有
统计学意义(P<0.05)。Logistic逐步回归分析显示椎体指数、L4椎体大小、L4椎体倾角、腰椎前凸角、骨盆投射角及
关节突关节角是L4椎体发生退变性滑脱的相关因素。结论 低椎体指数、小L4椎体，较大的L4椎体倾角、腰椎前
凸角、骨盆投射角及关节突关节角增大了L4椎体发生退变性滑脱的危险。

      【关键词】 退变性滑脱；第四腰椎椎体；影像学参数；危险因素

      【中图分类号】 R681.5+3 【文献标识码】 A 【文章编号】 1003—6350（2015）12—1772—03


Effect of radiographic parameters on the 4th lumbar degenerative spondylolisthesis.
WANG Yong-jiang.
Department of Spine Surgery, Ordos Central Hospital, Ordos 017000, Inner Mongolia, CHINA

【Abstract】 Objective To investigate the impact of radiographic parameters on the 4th lumbar (L4) degenera-
tive spondylolisthesis (DLS). Methods From May 2012 to September 2014, 56 patients with L4 degenerative spondy-
lolisthesis were enrolled in DLS group, and 56 healthy volunteers were recruited in control group. The participants in
both the two groups underwent lumbar lateral X-ray, CT and bone density examination. A series of radiographic pa-
rameters were measured on the basis of X-ray and CT results. Logistic regression analysis was used to analyze the risk
radiographic parameters of development of DLS. Results In DLS group, 49 cases of L4 spondylolisthesis were classi-
fied into gradeⅠ and 7 cases of L4 spondylolisthesis were classified into grade Ⅱ, with the average Boxall index of
(0.195±0.041). Compared with the control group, disc height, L4 vertebral size, disc index and vertebral bone miner-
al density of DLS group were significantly lower (P<0.05), but L4 vertebra inclination angle, lumbar lordosis, pelvic
incidence, lumbosacral angle of the DLS group were significantly larger (P<0.05). Patients in DLS group had more
sagittally orientated facet joints, more significant facet joints tropism and more horizontally orientated pedicle-facet
angle than the control group (P<0.05). Logistic regression analysis showed that disc index, L4 vertebral body size, L4
vertebra tilt, lumbar lordosis, pelvic incidence angle and facet joints were the risk factors of the L4 spondylolisthesis.
Conclusion Low disc index, smaller L4 vertebral size, larger L4 vertebra inclination angle, lumbar lordosis, pelvic in-
cidence angle and orientated facet joints are the risk factors of the development of L4 degenerative spondylolisthesis.

      【Key words】 Degenerative spondylolisthesis; The 4th lumbar; Radiographic parameters; Risk factors
·论 著·doi:10.3969/j.issn.1003-6350.2015.12.0634