目的 研究基于腰骶-骨盆矢状位参数改变探讨不同整脊牵引疗法治疗退变性腰椎滑脱症临床疗效的对比效果。 方法 选择2022年3月至2024年1月广东省中医院收治的108例退变性腰椎滑脱症患者的临床资料进行回顾性分析，以治疗方法不同分为三维组（n = 55）与四维组（n = 53）。四维组接受四维牵引联合基础治疗，三维组接受三维牵引联合基础治疗。对比两组腰骶-骨盆矢状位参数、椎体滑移复位程度、腰椎曲度值、腰椎冠状面Cobb角、腰椎功能、疼痛程度、临床疗效。 结果 治疗结束时、治疗后3个月，三维组和四维组骶骨倾斜角（SS）、腰椎前凸角（LL）水平低于治疗前，且治疗后3个月低于治疗结束时（P < 0.05）。治疗结束时，三维组SS、LL水平低于四维组（P < 0.05），治疗后3个月两组SS、LL比较差异无统计学意义（P > 0.05）。两组腰椎前凸指数、腰椎冠状面Cobb角均低于治疗前（P < 0.05），治疗后3个月，两组腰椎前凸指数、腰椎冠状面Cobb角均低于治疗结束时（P < 0.05）；治疗结束时，三维组腰椎前凸指数、腰椎冠状面Cobb角低四维组（P < 0.05）。治疗结束时、治疗后3个月，两组腰曲弓顶距离均高于治疗前（P < 0.05），治疗后3个月，两组腰曲弓顶距离均高于治疗结束时（P < 0.05）；治疗结束时，三维组腰曲弓顶距离高于四维组（P < 0.05）。治疗后3个月，两组腰椎前凸指数、腰椎冠状面Cobb角、腰曲弓顶距离比较差异无统计学意义（P > 0.05）。治疗结束时、治疗后3个月，两组视觉模拟疼痛评分法（VAS）评分均低于治疗前（P < 0.05），治疗后3个月，两组VAS评分均低于治疗结束时（P < 0.05）；治疗结束时、治疗后3个月，两组日本骨科协会评估治疗分数（JOA）均高于治疗前（P < 0.05），治疗后3个月，两组JOA评分均高于治疗结束时（P < 0.05）。治疗结束时、治疗后3个月，两组JOA评分、VAS评分比较差异无统计学意义（P > 0.05）。治疗结束、治疗后3个月，两组椎体滑移复位率比较差异无统计学意义（P > 0.05）。两组总有效率比较差异无统计学意义（P > 0.05）。 结论 四维牵引与三维牵引联合基础治疗退变性腰椎滑脱症疗效相当，均能有效减轻疼痛、改善腰椎功能，但三维牵引在改善患者腰椎功能与腰骶-骨盆矢状位参数，纠正腰椎曲度异常方面效果更好。

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.