腰椎崩裂性滑脱与椎管狭窄椎弓根CT影像比较△

Comparison of pedicle CT images of lumbar isthmic spondylolisthesis versus spinal stenosis

摘要:

[目的] 比较腰椎崩裂性滑脱和单纯腰椎管狭窄的腰椎椎弓根形态差异并分析其临床意义。[方法] 2020 年1 月—2023 年10 月在本院行腰椎后路椎弓根螺钉内固定手术的62 例L5 崩裂性滑脱（滑脱组） 和45 例单纯L5S1 椎管狭窄患者（狭窄组） 纳入本研究。滑脱组中Ⅰ度滑脱31 例，Ⅱ度滑脱31 例。比较滑脱组与狭窄组以及滑脱组内Ⅰ度滑脱和Ⅱ度滑脱各CT 参数的差异。[结果] 在L1~5 各层面，滑脱组患者的椎弓根内聚角（pedicle angle, PA) [(12.4±2.8)° vs (8.9±2.7)°, P＜0.001; (13.4±2.7)°vs (10.2±2.7)°, P＜0.001; (18.2±3.9)° vs (14.6±3.4)°, P＜0.001; (22.3±4.8)° vs (17.2±4.5)°, P＜0.001; (31.5±4.7)° vs (28.3±4.7)°, P=0.002]、椎弓根长度（pedicle length, PL) [(18.3±1.6) mm vs (17.4±1.6) mm, P=0.008; (17.1±1.3) mm vs (16.3±1.7) mm, P=0.020; (16.9±1.7) mmvs (16.1±1.7) mm, P=0.029; (14.7±1.4) mm vs (14.1±1.4) mm, P=0.018; (15.8±1.5) mm vs (14.3±2.1) mm, P＜0.001] 显著大于狭窄组患者，滑脱组的钉道长度（screw trajectory length, STL） 也均显著大于狭窄组患者（P＜0.05），而前者的椎弓根直径（pedicle width,PW） 在L1~5 各层面均显著小于后者（P＜0.05）。Ⅰ度滑脱和Ⅱ度滑脱之间所有CT 参数在L1~5 层面比较差异均无统计学意义（P＞0.05）。[结论] 腰椎崩裂性滑脱患者各节段腰椎椎弓根均呈现变细变长的形态学改变，这种改变可能与崩裂的发病原因有关。此类患者在置钉过程中应适当增大其内聚角度。

Abstract:

[Objective] To compare the morphological differences in lumbar pedicle between isthmic spondylolisthesis and simple lum-bar spinal stenosis, and analyze its clinical significance. [Methods] From January 2020 to October 2023, 62 patients with L5 isthmic spon-dylolisthesis (the IS group) and 45 patients with simple L5S1 spinal stenosis (the SS group) who underwent posterior pedicle screw internalfixation in our hospital were included in this study. There were 31 cases of grade I and 31 cases of grade II. The CT parameters were com-pared between the IS group and the SS group as well as the spondylolisthesis subgroups. [Results] From L1 to L5, the IS group proved signifi-cantly greater than the SS group in terms of pedicle angle (PA) [(12.4±2.8)° vs (8.9±2.7)°, P＜0.001; (13.4±2.7)° vs (10.2±2.7)°, P＜0.001;(18.2±3.9)° vs (14.6±3.4)°, P＜0.001; (22.3±4.8)° vs (17.2±4.5)°, P＜0.001; (31.5±4.7)° vs (28.3±4.7)°, P=0.002], and pedicle length (PL)[(18.3±1.6) mm vs (17.4±1.6) mm, P=0.008; (17.1±1.3) mm vs (16.3±1.7) mm, P=0.020; (16.9±1.7) mm vs (16.1±1.7) mm, P=0.029; (14.7±1.4) mm vs (14.1±1.4) mm, P=0.018; (15.8±1.5) mm vs (14.3±2.1) mm, P＜0.001]. In addition, the IS group had significantly greater screwtrajectory length (STL) than the SS group (P＜0.05), whereas the former had significantly less pedicle width (PW) than the latter from L1 toL5 levels (P＜0.05). However, there was no significant difference in all CT parameters from L1 to L5 levels between degree I and degree II ISsubgroups (P＞0.05). [Conclusion] The isthmic spondylolisthesis presents the lumbar pedicle change of thinning and lengthening, whichmay be related to the pathogenesis. The inward angle of pedicle screw placement should appropriately be increased.