天津医药

天津医药 ›› 2020, Vol. 48 ›› Issue (4): 294-297.doi: 10.11958/20192859

• 临床研究 • 上一篇    下一篇

腰椎管狭窄合并L3退行性脊柱滑脱的病理机制研究 #br#

王锟 1，孙晓亮 1△，吴国锋 1，周剑 1，孙晗 1，袁峰 2
  

  1. 1苏州大学附属第三医院骨关节科（邮编213000）；2徐州医科大学附属医院骨科
  • 收稿日期:2019-09-17 修回日期:2019-11-21 出版日期:2020-04-15 发布日期:2020-06-23
  • 通讯作者: 孙晓亮 E-mail:sunx1819@sohu.com
  • 作者简介:王锟（1984），男，硕士，主治医师，主要从事骨关节治疗和康复方面研究
  • 基金资助:
    江苏省卫生计生委2016年度面上科研课题（H201630）

The pathological mechanism of lumbar spinal stenosis with L3 degenerative spondylolisthesis #br#

WANG Kun1, SUN Xiao-liang1△, WU Guo-feng1, ZHOU Jian1, SUN Han1, YUAN Feng2 #br#   

  1. 1 Department of Orthopaedics, the Third Affiliated Hospital of Suzhou University, Changzhou, Jiangsu 213000, China;
    2 Department of Orthopaedics, the Affiliated Hospital of Xuzhou Medical University
  • Received:2019-09-17 Revised:2019-11-21 Published:2020-04-15 Online:2020-06-23
  • Contact: SUN Xiao-liang E-mail:sunx1819@sohu.com

PDF (PC)

3748

摘要： 目的 比较腰椎管狭窄症患者合并L3退行性脊柱滑脱（DS）与非L3 DS患者之间的影像学差异，探讨L3 DS
发生的可能病理机制。方法 苏州大学附属第三医院 2012年 5月—2017年 6月共收治 300例腰椎后路手术治疗的
腰椎管狭窄症患者，从中选出 35例仅合并 L3 DS的患者作为 L3 DS组，另选取年龄、性别相匹配的无 DS患者 40例为
非 DS组。所有患者均摄取站立位腰椎正侧位片、脊柱全长片及腰椎 MRI，在 X线片上测量骨盆投射角（PI）、骨盆倾
斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）；在 MRI上测量 L3/4、L4/5小关节角度及 L3/4、L4/5、L5/S1椎间盘高度。并对所有结果进行统计学分析。结果 2组患者脊柱-骨盆矢状面参数中PI、PT、SS、LL的比较差异均无统计学意义（P＞
0.05）。椎间盘的高度参数中L3 DS组L3、L4、L5坡度均大于非DS组（P＜0.01）。L3 DS组中L3/4小关节角度的矢状化明
显比非DS组显著（P＜0.01）；2组L3/4、L4/5和L5/S1椎间盘高度的比较差异均无统计学意义（P＞0.05）。L3 DS组中L4/5腰椎间盘高度降低比例多于非 L3 DS组（45.83% vs. 11.11%，χ2=5.357，P＜0.01）。结论 L3节段腰椎的坡度越大，L3/4小关节角度的矢状化及应力过度增加可能是导致L3 DS发生的重要原因。

关键词: 椎管狭窄, 脊椎滑脱, 椎关节突关节, 第3腰椎, 病理机制

Abstract: Objective To compare the imaging differences between patients with lumbar spinal stenosis combined with
L3 degenerative spondylolisthesis (DS) and patients without L3 DS, and to explore the possible pathological mechanism of L3 DS. Methods A total of 300 patients with lumbar spinal stenosis treated with lumbar posterior lumbar surgery were
selected in the Third Affiliated Hospital of Suzhou University from May 2012 to June 2017. Thirty-five patients from them
with L3 DS alone were selected as L3 DS group. Forty patients with matched age and gender and DS without lumbar spinal
stenosis were selected as non-DS groups. All patients received a standing lumbar vertebrae, a full length spine and lumbar
MRI, and measured pelvic projection angle (PI), pelvic tilt angle (PT), sacral tilt angle (SS), lumbar lordosis angle (LL) on Xray films. The facet joint angles of L3/4 and L4/5, and disc heights of L3/4, L4/5 and L5/S1 were measured on MRI. Statistical analysis was performed on all results. Results There were no significant differences in spine-pelvis sagittal plane
parameters PI, PT, SS and LL between the two groups (P＞0.05). Among the height parameters of intervertebral disc, the
slopes of L3, L4 and L5 were significantly greater in the L3 DS group than those in the non-DS group (P＜0.01). The sagittal angle of l3/4 facet joints was significantly higher in the L3 DS group than that in the non-DS group (P＜0.01). There were no significant differences in disc heights of L3/4, L4/5 and L5/S1 between the two groups (P＞0.05). The lumbar disc height of L4/5 was more lower in the L3 DS group than that in the non-L3 DS group (45.83% vs. 11.11%, χ2=5.357, P＜0.01). Conclusion The increase of slope of L3 segment, the sagittal angle of l3/4 facet joint and the excessive stress may be the important reasons leading to the occurrence of L3 DS.

Key words: spinal stenosis, spondylolysis, zygapophyseal joint, the third lumbar vertebra, pathological mechanism

中图分类号: