Li Y, Leng Y B, Tang C, Xu S C, He B Q, Zhou J J, Liao Y H, Tang Q, Wang Q, Zhong D J
Department of Orthopedics, the Affiliated Hospital of Southwest Medical University, Luzhou 646000, China.
Department of Orthopedics, the Fourth Affiliated Hospital of Southwest Medical University, Meishan 620564, China.
Zhonghua Wai Ke Za Zhi. 2025 Sep 1;63(9):806-813. doi: 10.3760/cma.j.cn112139-20241102-00487.
To analyzed the correlation between the sacral slope (SS) and the slip degree of vertebral body, the morphological parameters of intervertebral disc, paraspinal muscle and pedicle in patient with degenerative lumbar spondylolisthesis (DLS). A retrospective cohort study was conducted. One hundred and forty patients with L degenerative spondylolisthesis who visited the Department of Orthopedics, the Affiliated Hospital of Southwest Medical University from July 2018 to October 2022 were included. There were 32 males and 108 females, with an age of (62.6±10.0) years (range: 42 to 87 years) and the body mass index was (23.8±2.8) kg/m(range: 14.7 to 28.7 kg/m). General information and imaging data (lumbar X-ray, CT three-dimensional reconstruction, MRI images) of the patients were collected. SS and the slip degree (SD) of the L vertebral body were measured on lateral lumbar radiographs. Based on Roussouly classification, 140 patients with DLS were divided into a low SS group (SS<35°), a medium SS group (35°≤SS<45°), and a high SS group (SS≥45°). The morphological parameters of the L pedicle of the patient were measured on the lumbar CT three-dimensional reconstruction images, including pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle camber angle(PCA) and pedicle height (PH). The morphological parameters of the paraspinal muscles (psoas major, multifidus and erector spinae) were measured on MRI images, including total cross-sectional muscle area (TCSA), functional cross-sectional muscle area (FCSA), and the ratio of functional cross-sectional muscle area (FCSA/TCSA) was calculated. The degree of degeneration of the L disc was assessed on MRI images. The slip degree, morphological parameters of the pedicle, intervertebral disc, and paraspinal muscles among the groups were compared and their correlation was analyzed. The comparison of quantitative data was conducted using one-way analysis of variance, and the post hoc analysis for pairwise comparisons among groups was performed using the least significant difference method. The comparison of unordered categorical data was carried out using the test, and the comparison of ordered categorical data was conducted using the Kruskal-Wallis rank sum test. Pearson correlation analysis was used to test the correlation. Among the 140 patients, there were 70 in the low SS group, 48 in the medium SS group, and 22 in the high SS group. The SD and PL of the low SS group were the lowest ((18.6±4.2)%, (14.0±1.0) mm), those of the medium SS group were slightly higher ((21.0±3.6)%, (15.7±0.9) mm), and those of the high SS group were the highest ((23.7±2.8)%, (16.2±0.7) mm), with statistically significant differences among the groups (all <0.01). The PW, PH and PCA of the low SS group were the highest ((11.0±1.1) mm, (11.0±1.0) mm, 22.9°±1.1°), those of the medium SS group were slightly lower ((10.2±1.1) mm, (10.4±0.9) mm, 21.6°±1.3°), and those of the high SS group were the lowest ((9.6±0.9) mm, (9.4±0.7) mm, 18.7°±1.5°), with statistically significant differences among the groups (all <0.05). The FSCA/TCSA of the psoas major, erector spinae and multifidus muscles in the low SS group were the highest ((93.1±4.0)% and (77.6±6.4) %), next were those in the medium SS group ((90.9±3.5)% and (74.9±6.1)%), and those in the high SS group were the lowest ((88.6±4.4)% and (71.2±7.4) %), with statistically significant differences among the different groups (all <0.05). Pearson correlation analysis showed that SS was positively correlated with SD(=0.557,<0.01); SS was negatively correlated with the FSCA/TCSA of the paraspinal muscles (psoas major, erector spinae+multifidus) (=-0.393,-0.394,both <0.01); SS was positively correlated with PL and PSTL (=0.706,<0.01;=0.264, <0.01), and negatively correlated with PW, PCA and PH (=-0.469,-0.669,-0.549, all <0.01). The Pfirrmann grade of intervertebral disc degeneration in the low SS group was better than that in the medium SS group and the high SS group(=23.128,<0.01). In DLS patients, as SS increases, the SD of the L vertebral body gradually increases, the proportion of paraspinal muscle functional area gradually decreases, the degree of intervertebral disc degeneration gradually worsens, the pedicle gradually becomes slender, and the pedicle camber angle gradually decreases. There is a correlation between SS and the degree of vertebral slippage, as well as morphological parameters of pedicle, intervertebral disc, and paraspinal muscles.
分析退行性腰椎滑脱症（DLS）患者的骶骨倾斜度（SS）与椎体滑脱程度、椎间盘、椎旁肌及椎弓根形态学参数之间的相关性。进行一项回顾性队列研究。纳入2018年7月至2022年10月在西南医科大学附属医院骨科就诊的140例L节段退行性腰椎滑脱症患者。其中男性32例，女性108例，年龄（62.6±10.0）岁（范围：42至87岁），体重指数为（23.8±2.8）kg/m²（范围：14.7至28.7 kg/m²）。收集患者的一般资料和影像学数据（腰椎X线、CT三维重建、MRI图像）。在腰椎侧位X线片上测量L椎体的SS和滑脱程度（SD）。根据Roussouly分类，将140例DLS患者分为低SS组（SS<35°）、中SS组（35°≤SS<45°）和高SS组（SS≥45°）。在腰椎CT三维重建图像上测量患者L椎弓根的形态学参数，包括椎弓根长度（PL）、椎弓根宽度（PW）、椎弓根螺钉轨迹长度（PSTL）、椎弓根弯角（PCA）和椎弓根高度（PH）。在MRI图像上测量椎旁肌（腰大肌、多裂肌和竖脊肌）的形态学参数，包括肌肉总横截面积（TCSA）、功能横截面积（FCSA），并计算功能横截面积与总横截面积的比值（FCSA/TCSA）。在MRI图像上评估L椎间盘的退变程度。比较各组间的滑脱程度、椎弓根、椎间盘及椎旁肌的形态学参数，并分析其相关性。定量数据的比较采用单因素方差分析，组间两两比较的事后分析采用最小显著差异法。无序分类数据的比较采用检验，有序分类数据的比较采用Kruskal-Wallis秩和检验。采用Pearson相关分析检验相关性。140例患者中，低SS组70例，中SS组48例，高SS组22例。低SS组的SD和PL最低（分别为（18.6±4.2）%、（14.0±1.0）mm），中SS组略高（分别为（21.0±3.6）%、（15.7±0.9）mm），高SS组最高（分别为（23.7±2.8）%、（16.2±0.7）mm），组间差异有统计学意义（均P<0.01）。低SS组的PW、PH和PCA最高（分别为（11.0±1.1）mm、（11.0±1.0）mm、22.9°±1.1°），中SS组略低（分别为（10.2±1.1）mm、（10.4±0.9）mm、21.6°±1.3°），高SS组最低（分别为（9.6±0.9）mm、（9.4±0.7）mm、18.7°±1.5°），组间差异有统计学意义（均P<0.05）。低SS组腰大肌、竖脊肌和多裂肌的FCSA/TCSA最高（分别为（93.1±4.0）%和（77.6±6.4）%），其次是中SS组（分别为（90.9±3.5）%和（74.9±6.1）%），高SS组最低（分别为（88.6±4.4）%和（71.2±7.4）%），不同组间差异有统计学意义（均P<0.05）。Pearson相关分析显示，SS与SD呈正相关（r=0.557，P<0.01）；SS与椎旁肌（腰大肌、竖脊肌+多裂肌）的FCSA/TCSA呈负相关（r=-0.393、-0.394，均P<0.01）；SS与PL和PSTL呈正相关（r=0.706，P<0.01；r=0.264，P<0.01），与PW、PCA和PH呈负相关（r=-0.469、-0.669、-0.549，均P<0.01）。低SS组椎间盘退变的Pfirrmann分级优于中SS组和高SS组（P=23.128，P<0.01）。在DLS患者中，随着SS增加，L椎体的SD逐渐增大，椎旁肌功能面积比例逐渐减小，椎间盘退变程度逐渐加重，椎弓根逐渐变细，椎弓根弯角逐渐减小。SS与椎体滑脱程度以及椎弓根、椎间盘和椎旁肌的形态学参数之间存在相关性。
Zhongguo Gu Shang. 2025-8-25
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