关键词: 腰骶-骨盆矢状位参数, 四维牵引, 三维牵引, 退变性腰椎滑脱症, 临床疗效

Abstract:

Objective To investigate the comparative effect of different spinal traction therapy on the treatment of degenerative lumbar spondylolisthesis based on the change of lumbosacral and pelvic sagittal position parameters. Methods The clinical data of 108 patients with degenerative lumbar spondylolisthesis admitted to Guangdong Provincial Hospital of Traditional Chinese Medicine from March 2022 to January 2024 were selected for retrospective analysis， and they were divided into the three-dimensional group （n = 55） and the four-dimensional group （n = 53） according to the difference in treatment methods. The four dimensional group received four dimensional traction combined with basic treatment， and the three dimensional group received three dimensional traction combined with basic treatment. Lumbosacral pelvis sagittal position parameters， vertebral glide reduction degree， lumbar curvature value， coronal Cobb Angle of lumbar spine， lumbar function， pain degree and clinical efficacy were compared between the two groups. Results At the end of treatment and 3 months after treatment， the levels of sacral inclination Angle （SS） and lumbar lordosis Angle （LL） in 3D and 4D groups were lower than before treatment， and at 3 months after treatment were lower than at the end of treatment （P < 0.05）. At the end of treatment， SS and LL levels in 3D group were lower than those in 4D group （P < 0.05）， while there was no difference in SS and LL levels between the two groups at 3 months after treatment （P > 0.05）. The lumbar lordotic index and coronal Cobb Angle of both groups were lower than before treatment （P < 0.05）， and at 3 months after treatment， the lumbar lordotic index and coronal Cobb Angle of both groups were lower than at the end of treatment （P < 0.05）. At the end of treatment， the lumbar protrusion index and coronal Cobb Angle in the three-dimensional group were lower than those in the four-dimensional group （P < 0.05）. At the end of treatment and 3 months after treatment， the distance of lumbar arch top in both groups was higher than before treatment （P < 0.05）， and at 3 months after treatment， the distance of lumbar arch top in both groups was higher than at the end of treatment （P < 0.05）. At the end of treatment， the distance of lumbar arch in the three-dimensional group was higher than that in the four-dimensional group （P < 0.05）. At 3 months after treatment， there were no significant differences in lumbar lordosis index， coronal Cobb Angle of lumbar spine and distance between the two groups （P > 0.05）. At the end of treatment and 3 months after treatment， visual analogue pain scale （VAS） scores in both groups were lower than before treatment （P < 0.05）， and at 3 months after treatment， VAS scores in both groups were lower than at the end of treatment （P < 0.05）. At the end of treatment and 3 months after treatment， the Japanese Orthopaedic Association evaluated treatment score （JOA） in both groups was higher than that before treatment （P < 0.05）， and at 3 months after treatment， the JOA score in both groups was higher than that at the end of treatment （P < 0.05）. At the end of treatment and 3 months after treatment， there was no significant difference in JOA score and VAS score between the two groups （P > 0.05）. At the end of treatment and 3 months after treatment， there was no difference in the reduction rate of vertebral slippage between the two groups （P > 0.05）. There was no difference in total effective rate between the two groups （P > 0.05）. Conclusion Four dimensional traction and three dimensional traction combined with basic treatment of degenerative lumbar spondylolisthesis have the same efficacy， both can effectively reduce pain and improve lumbar function， but three dimensional traction is better in improving lumbar function and lumbosacral pelvic sagittal position parameters， and correcting lumbar curvature abnormalities.

Key words: lumbosacral pelvis sagittal position parameters, four-dimensional traction, three-dimensional traction, degenerative lumbar spondylolisthesis, clinical effect