基于CT观察退变性腰椎滑脱症与关节突关节角及关节椎弓根角的关系

doi:10.3969/j.issn.1006-6233.2024.02.023

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Abstract Objective: To explore the relationship between degenerative lumbar spondylolisthesis (DLS) and facet joint angles and zygapophyseal articular process root angles based on CT observation. Methods: A retrospective analysis was conducted on 169 patients diagnosed with DLS at Sichuan Provincial Orthopedic Hospital from January 2020 to June 2022 (DLS group). Additionally, 169 age-matched patients with lumbar and leg pain but without lumbar spondylolisthesis, who underwent physical examinations during the same period, were selected as the healthy control group. Clinical data were compared between the two groups, and both univariate and multivariate logistic regression analyses were performed to identify factors influencing DLS. Smooth curve fitting was used to analyze the curve relationship between facet joint angles, zygapophyseal articular process root angles, and DLS. A Bayesian network model was constructed, and its predictive performance was validated. Results: Univariate analysis revealed that BMI, intervertebral disc degeneration, systemic joint laxity, changes in lumbar spine structure and curvature, ligament laxity, osteoporosis, decalcification, lumbar facet joint lesions, and comorbid diabetes were higher in the DLS group than in the healthy group (P<0.05). The facet joint angles in the DLS group were smaller than those in the healthy group, and the proportion of individuals with asymmetrical facet joint angles and degeneration degrees of 1 and 2 increased, while the zygapophyseal articular process root angle significantly increased (P<0.05). Multivariate analysis indicated that an increase in BMI, intervertebral disc degeneration, changes in lumbar spine structure and curvature, ligament laxity, osteoporosis, decalcification, systemic joint laxity, lumbar facet joint lesions, comorbid diabetes, decrease in facet joint angles, asymmetry of facet joint angles, degeneration of facet joint angles, and an increase in zygapophyseal articular process root angles were all risk factors for DLS (OR>1, P<0.05). Smooth curve fitting results demonstrated a positive correlation between zygapophyseal articular process root angles and DLS within a certain range, while facet joint angles showed a negative correlation with DLS. The Bayesian network model and predictive reasoning revealed that an increase in BMI, decrease in facet joint angles, asymmetry of facet joint angles, and an increase in zygapophyseal articular process root angles were directly associated with DLS. When the probability of decreased facet joint angles, asymmetry of facet joint angles, and an increase in zygapophyseal articular process root angles reached zero, the occurrence rate of DLS decreased from 50% to 37.2%. Model validation confirmed the good discriminability, accuracy, and effectiveness of the Bayesian network predictive model. Conclusion: CT observation provides a more accurate diagnosis of DLS, and within a certain range, facet joint angles and zygapophyseal articular process root angles are correlated with DLS.

Key words： Degenerative lumbar spondylolisthesis Computer tomography Angles of zygapophysial joints Pedicle facet angle Correlation Bayesian network model

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2024.02.023 OR http://www.hbyxzzs.cn/EN/Y2024/V30/I2/290

[1] 杜英杰,李晓军,王玉满.OLIF联合后路固定术治疗腰椎滑脱椎管狭窄患者的CT、MRI观察[J].影像科学与光化学,2022,40(2):325-330.
[2] 常晓娟,于杰,谢瑞,等.退行性腰椎滑脱症的现代中医研究进展[J].天津中医药,2020,37(3):345-349.
[3] Garcia-Ramos CL,Valenzuela-Gonzalez J,Baeza-alvarez VB, et al.Lumbar degenerative spondylolisthesis Ⅱ:treatment and controversies[J].Acta Ortop Mex,2020,34(6):433-440.
[4] Austevoll IM,Hermansen E,Fagerland MW,et al.Decompression with or without fusion in degenerative lumbar spondylolisthesis[J].N Engl Med,2021,385(6):526-538.
[5] 胥少汀,葛宝丰,徐印坎.实用骨科学[M].北京:人民军医出版社,2005.1200.
[6] Zhou LJ,Yang M,Zheng WW,et al.Analysis of characteristics of lumbar spine-pelvic structural parameters in degenerative lumbar spondylolisthesis[J].Zhongguo Gu Shang,2020,33(9):862-866.
[7] 邢建强,王大巍,王子龙,等.斜外侧腰椎间融合术治疗单节段退变性腰椎滑脱症早中期疗效分析[J].颈腰痛杂志,2023,44(1):96-98.
[8] Yoshihara H.Pathomechanisms and predisposing factors for degenerative lumbar spondylolisthesis:a narrative review[J].JBJS Rev,2020,8(9):e2000068.
[9] Guo M,Kong C,Sun S,et al.Predictors of L4-L5 degenerative lumbar spondylolisthesis:L4 inclination angle and facet joint angle[J].World Neurosurg,2019,(130):e680-e686.
[10] Wang PT,Zhang JN,Liu TJ,et al.Multivariate analysis of pedicle screw invasion of the proximal facet joint after lumbar surgery[J].BMC Musculoskelet Disord,2022,23(1):39.
[11] Morimoto M,Higashino K,Manabe H,et al.Age-related changes in axial and sagittal orientation of the facet joints:comparison with changes in degenerative spondylolisthesis[J].Orthop Sci,2019,24(1):50-56.
[12] Naeem K,Nathani KR,Barakzai MD,et al.Modifications in lumbar facet joint are associated with spondylolisthesis in the degenerative spine diseases:a comparative analysis[J].Acta Neurochir (Wien),2021,163(3):863-871.