退变性腰椎滑脱与腰椎管狭窄症在脊柱骨盆矢状位参数之间的差异

发布时间：2018-04-14 23:33

本文选题：退变性腰椎滑脱 + 退变性腰椎管狭窄症　；参考：《宁夏医科大学》2017年硕士论文

【摘要】：目的:1.比较脊柱骨盆参数在退变性腰椎滑脱和退变性腰椎管狭窄症患者以及正常国人之间的差异。2.探讨退变性腰椎滑脱发生及发展的危险因素方法:1.从2016年2月至2017年2月期间住院病例中选出退变性腰椎滑脱及退变性腰椎管狭窄症病例71例,其中退变性腰椎滑脱患者36例,男性2例,女性34例,平均年龄61.14±8.61(46~83)岁,退变性腰椎管狭窄症患者35例,男性22例,女性13例,平均年龄60.57±9.67(40~81)岁。全部病例均具有完整的影像学资料全脊柱侧位X-ray片,同时在全脊柱侧位片上测量如下参数:骨盆投射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、腰椎前凸角(LL)、胸椎后凸角(TK)、骨盆角(PA)、腰椎骨盆前凸(PR-LI—PR-L5)、总腰椎骨盆前凸角(PR-T12)、PR-S1、矢状面垂轴(SVA)、腰4椎体倾斜角(L4S)、腰5椎体倾斜角(L5S)。2.所测退变性腰椎滑脱及腰椎管狭窄症病例参数分别与正常国人脊柱骨盆参数进行比较,采用两独立样本t检验比较两组参数间的差异,两组病例脊柱骨盆参数均采用pearson相关分别进行相关性分析,P0.05为差异有统计学意义。结果:1.退变性腰椎滑脱组PI、SS、LL明显大于退变性腰椎管狭窄症组及国人正常参考值(P0.01);2.PT、PA、SVA在退变性腰椎滑脱及退变性腰椎管狭窄症组均明显大于国人正常参考值(P0.01),退变性腰椎滑脱PR-T12与正常参考值相比无差异(P0.05),退变性腰椎管狭窄症组PR-T12小于正常参考值(P0.01);3.退变性腰椎滑脱PR-L4、PR-L5及PR-S1明显小于退变性腰椎管狭窄症组(P0.01);4.退变性腰椎滑脱组PR-T12与PA(r=-0.829,P0.001)的相关性强于PR-T12与LL(r=0.664,P0.001)、TK(r=0.582,P0.001)的相关性,在退变性腰椎管狭窄症组中,PR-T12与LL(r=0.854,P0.001)、TK(r=0.616,P0.001)相关性强于PR-T12与PA(r=-0.582,P0.001)的相关性。结论:1.为了维持全脊柱矢状位平衡脊柱及骨盆空间结构不断发生改变,退变性腰椎滑脱及退变性腰椎管狭窄症患者脊柱矢状位结构与骨盆结构改变表现并不完全相同。2.高PI可能引起退变性腰椎滑脱发生及发展,退变性腰椎滑脱下腰椎骨盆前凸明显小于退变性腰椎管狭窄症(PR参数取正值)。3.退变性腰椎滑脱及退变性腰椎管狭窄症患者可能具有不同的代偿机制。
[Abstract]:Purpose 1.To compare the difference of spinal pelvic parameters between degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis and normal Chinese.To explore the risk factors for the occurrence and development of degenerative lumbar spondylolisthesis: 1.From February 2016 to February 2017, 71 cases of degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis were selected, including 36 cases of degenerative lumbar spondylolisthesis, 2 males and 34 females, with an average age of 61.14 卤8.61 卤460-83 years.There were 35 cases of degenerative lumbar spinal stenosis, including 22 males and 13 females, with an average age of 60.57 卤9.67m 4081 years.All the patients had complete imaging data, all of them had lateral X-ray film of the spine.At the same time, the following parameters were measured on lateral radiographs of the whole spine: pelvis projection angle (Pi), sacral obliquity angle (SSS), pelvic obliquity angle (PTT), lumbar anterior kyphosis (LLL), thoracic kyphosis (TK), pelvic angle (PAA), pelvic protuberance (PR-LI-PR-L5), total lumbar pelvic kyphosis angle (PR-T12) PR-S1, sagittal.In the vertical axis of the shape plane, SVA, L4, L5, L5, L5, and L4, L4, and L5, respectively, were found in the vertical axis, L4, L4, L5, and L5, respectively.The parameters of degenerative lumbar spondylolisthesis and lumbar spinal stenosis were compared with those of normal Chinese.Pearson correlation was used to analyze the correlation between the two groups.The result is 1: 1.PISSLL in degenerative lumbar spondylolisthesis group was significantly higher than that in degenerative lumbar spinal stenosis group and Chinese normal reference value P0.01 / 2. PTPASVA in degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis group was significantly higher than that in Chinese normal reference value (P0.01), and degenerative lumbar spondylolisthesis group was significantly higher than that in Chinese normal reference value (P0.01).There was no difference between PR-T12 and normal reference value (P 0.05). The PR-T12 of degenerative lumbar spinal stenosis group was lower than that of normal reference value (P 0.01).PR-L _ 4 and PR-L _ 5 and PR-S1 of degenerative lumbar spondylolisthesis were significantly lower than that of degenerative lumbar spinal stenosis group (P 0.01).In degenerative lumbar spondylolisthesis group, the correlation between PR-T12 and P0.001 was stronger than that between PR-T12 and PR-T12. The correlation between PR-T12 and LLr0.854P0.001P0.001) was stronger than that between PR-T12 and PARM-0.582P0.001) in patients with degenerative lumbar spinal stenosis, the correlation between PR-T12 and P0.001 was stronger than that between PR-T12 and PARG-0.582P0.001. The correlation between PR-T12 and P0.001 was stronger than that between PR-T12 and PAR-0.582P0.001) in degenerative lumbar spondylolisthesis group (P 0.001), and the correlation between PR-T12 and LLR 0.854P 0.001 (P 0.001) was stronger than that between PR-T12 and PR-T12 (P 0.001).Conclusion 1.In order to maintain the sagittal balance of the whole spine and the spatial structure of the pelvis, the changes of the sagittal and pelvic structures in the patients with degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis were not identical.High Pi may lead to the occurrence and development of degenerative lumbar spondylolisthesis. The lumbar pelvic lordosis in degenerative lumbar spondylolisthesis is significantly lower than that in degenerative lumbar spinal stenosis.Degenerative lumbar spondylolisthesis and degenerative lumbar spinal stenosis may have different compensatory mechanisms.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.5

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