目的 比较退行性腰椎侧弯（Degenerative lumbar scoliosis，DLS）患者和无退行性腰椎侧弯（No degenerative lumbar scoliosis，NS）患者的L3椎弓根形态学参数并分析其临床意义。 方法 收集广东医科大学附属高州人民医院2018~2023年度住院治疗的DLS影像学资料，同时按照1:1匹配年龄、性别、身高和体重相近的患者作为对照组。测量并收集L3椎体的椎弓根长度（PL）、椎弓根宽度（PW）、椎弓根螺钉轨迹长度（PSTL），椎弓根外倾角（PCA）和椎弓根高度（PH）、Cobb角。比较两组L3椎弓根的形态学参数差异，分析腰椎Cobb角与椎弓根形态学参数之间的相关性。 结果 共收集56位DLS患者作为DLS组，并匹配56位NS患者作为对照组（NS组）。两组患者的性别比、年龄、身高、体重和体重指数无统计学意义（P>0.05）。与NS组相比，DLS组L3凸侧椎弓根PL、PW、PCA、PSTL显著变小（P<0.05），PH二者无统计学意义（P>0.05）；凹侧椎弓根PL、PW显著变小（P<0.05），而PCA、PSTL显著变大（P<0.05）, PH二者无统计学意义（P>0.05）。DLS组凸侧椎弓根相较于凹侧PL更长、PW更宽、PCA更小和PSTL更短（P<0.05）, PH无统计学意义(P>0.05)。DLS组患者的Cobb角与凸侧椎弓根PL、PW、PCA和PSTL均呈负相关。与凹侧椎弓根PL、PW呈负相关,但与PCA和PSTL呈正相关。DLS组患者的Cobb角度也与凹侧凸侧PL差值、PW差值、和PSTL差值相关。 结论 DLS组L3凸侧椎弓根相对于NS组表现为“短”、“细”、“收”的变化，凹侧椎弓根表现为“短”、“细”、“展”的形态学改变。凹、凸侧不对称，其中凹侧椎弓根最为纤细，且外倾角较大，使DLS患者在凹侧椎弓根螺钉置入时更易发生意外。
Abstract
Objective To compare the morphological parameters of L3 pedicles between patients with degenerative lumbar scoliosis (DLS) and patients without degenerative lumbar scoliosis (NS) and to analyze their clinical significance. Methods DLS imaging data of inpatient treatment in Gaozhou People's Hospital affiliated to Guangdong Medical University from 2018 to 2023 were collected, and patients with similar age, gender, height and weight were matched 1:1 as the control group. The pedicle length (PL), pedicle width (PW), pedicle screw trajectory length (PSTL), pedicle camber angle (PCA), pedicle height (PH) and Cobb angle of L3 vertebral body were measured and collected. The morphological parameters of L3 pedicles were compared between the two groups, and the correlation between lumbar Cobb angle and pedicle morphological parameters was analyzed. Results A total of 56 patients with DLS were collected as the DLS group, and 56 patients with NS were matched as control group (NS group). There were no significant differences in sex ratio, age, height, body weight and body mass index between two groups (P>0.05). Compared with NS group, the PL, PW, PCA, and PSTL of pedicles on the L3 convex side of the DLS group were significantly smaller (P<0.05), and PH was not statistically significant (P>0.05). PL and PW of concave pedicle were significantly smaller (P<0.05), while PCA and PSTL were significantly larger (P<0.05), and PH was not statistically significant (P>0.05). Compared with concave side, convex pedicle had longer PL, wider PW, smaller PCA and shorter PSTL than concave pedicles in DLS group (P<0.05), and PH was not statistically significant (P>0.05). Cobb angle in DLS group was negatively correlated with convex pedicle PL, PW, PCA and PSTL. It was negatively correlated with PL and PW in concave pedicles, but positively correlated with PCA and PSTL. Cobb angle of patients in DLS group was also correlated with the difference of PL, PW, and PSTL on concave side of convex side. Conclusions Compared with NS group, the pedicles on L3 convex side of DLS group showed changes of "short", "thin" and "retracted", and the pedicles on concave side showed morphological changes of "short", "thin" and "extended". The concave and convex sides are asymmetrical, among which concave pedicle is the most slender and the camber angle is large, which makes DLS patients more prone to accidents when concave pedicle screw is inserted.
关键词
退行性腰椎侧弯 /
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椎弓根参数 /
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Cobb角
Key words
Degenerative lumbar scoliosis /
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Pedicle parameters /
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Cobb angle
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基金
广东省医学科研基金项目（B2023375）；广东省自然科学基金项目（2024A1515013042）
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