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目的 :研究青少年L5/S1发育不良性滑脱患者的骶骨矢状面形态。方法 :回顾性分析2002年5月~2016年3月入院手术治疗的13例青少年L5/S1发育不良性滑脱患者,男2例,女11例,年龄12.2±3.1岁(9~18岁)。以年龄匹配的30例正常青少年为对照组。在站立位全脊柱侧位X线片上测量骶骨形态、姿势等参数。采用独立样本t检验对滑脱组和对照组以及滑脱组内低度发育不良亚组和高度发育不良亚组的各参数进行对比分析。结果:滑脱组患者中,10例存在S1上终板拱顶样改变,6例L5椎体楔形变,9例L5-S1后凸成角畸形。其腰骶角、骶骨平台角和S1指数均显著低于对照组;骶骨形态也异于对照组,骶骨角和S1上角显著小于对照组,骶骨头端(S1)曲度减小,然而骶骨的整体后凸角度显著大于对照组(Cobb法:50.1°±10.6°比18.1°±10.4°;Ferguson法:40.5°±9.9°比23.1°±11.5°)。滑脱组矢状面平衡显著大于对照组(46.5±42.3mm比-25.6±21.8mm),且其骨盆入射角、L5入射角、骨盆倾斜角、骨盆矢状面厚度均显著大于对照组(P<0.01),而骶骨倾斜角却显著小于对照组(P<0.05)。滑脱组呈现出躯干明显前倾、骨盆后旋、骶骨直立的姿态。滑脱组中高度发育不良8例,低度发育不良5例。高度发育不良组与低度发育不良组相比,其滑脱程度、骶骨后凸角及矢状面轴向垂直距离均显著增大[(67.3±18.6)%比(45.4±12.5)%;45.8°±8.4°比32.2°±5.1°;52.6±24.7mm比21.6±9.5mm(P<0.05)。结论:青少年L5/S1发育不良性腰椎滑脱患者除腰骶局部发育不良外,骶骨呈明显后凸形态。因躯干前倾,骨盆后旋和骶骨垂直化以代偿矢状面失衡,而这些异常形态受发育不良程度影响。
AIM: To study the sacral sagittal morphology of adolescent L5 / S1 dysplastic spondylolisthesis. Methods: Thirteen adolescent L5 / S1 dysplastic spondylolisthesis patients admitted to our hospital from May 2002 to March 2016 were retrospectively analyzed. There were 2 males and 11 females, aged 12.2 ± 3.1 years (range, 9-18 years). Age matched 30 normal adolescents as control group. In the standing position of the whole lateral scoliosis X-ray film measuring sacral shape, posture and other parameters. The independent sample t-test was used to compare the parameters of the spondylolisthesis group and the control group, as well as the low dysplastic subgroup and the high dysplastic subgroup in the spondylolisthesis group. Results: In the patients with spondylolisthesis, there were 10 cases of vault-like endplate apical changes in S1, 6 cases of L5 vertebral body wedging and 9 cases of L5-S1 kyphosis. The lumbosacral angle, sacral floor angle and S1 index were significantly lower than those of the control group. The shape of the sacrum was also different from that of the control group. The sacral angle and the upper S1 angle were significantly smaller than those of the control group, while the curvature of the sacral head (S1) (Cobb’s method: 50.1 ° ± 10.6 ° vs. 18.1 ° ± 10.4 °; Ferguson’s method: 40.5 ° ± 9.9 ° vs. 23.1 ° ± 11.5 °). The balance of sagittal plane in spondylolisthesis group was significantly larger than that in control group (46.5 ± 42.3mm vs. -25.6 ± 21.8mm), and its pelvic incidence angle, L5 incidence angle, pelvic tilt angle and pelvis sagittal thickness were significantly greater than those in control group (P < 0.01), while the sacral tilt angle was significantly less than the control group (P <0.05). The slippage group showed a significant forward torso, posterior pelvic rotation, sacral posture upright. In spondylolisthesis, 8 cases were highly dysplastic and 5 cases were poorly developed. The degree of spondylolisthesis, the degree of sacral kyphosis, and the axial vertical distance of sagittal plane were significantly higher in the group of high degree of dysplasia compared with those of low degree of dysplasia [(67.3 ± 18.6)% vs (45.4 ± 12.5)%, 45.8 ° ± 8.4 ° vs. 32.2 ° ± 5.1 °; 52.6 ± 24.7 mm vs. 21.6 ± 9.5 mm (P <0.05). Conclusion: In addition to lumbosacral dysplasia in adolescent L5 / S1 dysplastic lumbar spondylolisthesis, the sacral was obviously kyphosis. Due to trunk anteversion, pelvic rotation and sacrum vertical to compensate for sagittal imbalance, and these abnormal morphology affected by the degree of dysplasia.