60岁以上脊柱畸形患者脊柱-骨盆矢状面参数与生活质量的相关性分析

Correlation analysis of spinopelvic parameters and quality of life in the adult deformity patients over 60 years old

中文关键词:  成人脊柱畸形  矢状面  生活质量  SRS-22

英文关键词:Adult deformity  Sagittal  Quality of life  SRS-22

中文摘要:

  【摘要】 目的：探讨60岁以上脊柱畸形患者脊柱-骨盆矢状面参数与生活质量的相关性。方法：2014年3月~2016年5月60岁以上存在脊柱侧凸>20°、矢状面躯干偏移（sagittal vertical axis，SVA）>5cm或骨盆倾斜角（pelvic tilt，PT）>25°的脊柱畸形患者共43例被纳入研究，男7例，女36例，年龄64.0±3.5岁（60.0~73.0岁），其中退变性脊柱侧凸12例，退变性脊柱后凸畸形7例，退变性脊柱侧后凸畸形12例，特发性脊柱侧凸6例，特发性脊柱侧后凸畸形1例，陈旧性脊柱骨折伴后凸畸形5例。使用Scoliosis Research Society（SRS）-22量表、Oswestry功能障碍指数（Oswestry disability index，ODI）量表以及背部和下肢疼痛视觉模拟评分（the visual analog scale，VAS）评估患者的生活质量；在站立位全脊柱侧位X线片上测量脊柱-骨盆矢状面参数，包括SVA、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、PT、骶骨倾斜角（sacral slope，SS）和T1骨盆角（T1 pelvic angle，TPA）。计算PI减LL，即PI-LL值。采用Pearson相关性检验分析脊柱-骨盆矢状面参数与生活质量的相关性。结果：SRS-22量表中功能状态、疼痛、自我形象、心理状况及亚总分分别为13.4±2.1分、17.3±2.7分、13.2±3.0分、15.7±11.8分及59.6±5.6分；ODI、背部及下肢疼痛VAS评分分别为（46.8±17.8）%、5.7±2.6分和3.9±3.0分。SVA、TK、LL、PI、PT、SS、TPA和PI-LL分别为6.5±6.2cm、12.7°±15.8°、-16.9°±17.2°、49.0°±12.3°、30.2°±11.6°、18.8°±10.6°、28.8°±14.4°和32.1°±17.8°。SVA和TPA与SRS-22量表中功能状况、疼痛、自我形象、SRS-22亚总分、ODI及背部疼痛VAS评分显著相关（r=-0.386、-0.375、-0.361、-0.410、0.445、0.389，P<0.05；r=-0.403、-0.426、-0.466、-0.425、0.512、0.465，P<0.05）；LL、PT、PI-LL与ODI及背部疼痛VAS评分显著相关（r=0.368、0.367，P<0.05；r=0.376、0.341，P<0.05；r=0.401、0.395，P<0.05）；TK、PI和SS与生活质量各量表评分均无关（P>0.05）。结论：在60岁以上脊柱畸形患者中，TPA和SVA增大会增加患者功能障碍、腰背部疼痛程度并降低患者自我形象；LL减小、PT和PI-LL增大会加重患者腰背部疼痛程度。TPA能同时反映脊柱和骨盆矢状面状态，和生活质量相关性最强。

英文摘要:

  【Abstract】 Objectives: To investigate the correlations of spinopelvic parameters and quality of life in the adult deformity patients over 60 years old. Methods: From March 2014 to May 2016, 43 adult deformity patients (scoliosis with a Cobb angle of >20°, sagittal vertical axis of >5cm, or pelvic tilt >25°) over 60 years old were included, consisting of 12 adult degenerative scoliosis patients, 7 adult degenerative kyphosis patients, 12 adult degenerative kyphoscoliosis patients, 6 adult idiopathic scoliosis patients, 1 adult idiopathic kyphoscoliosi patient, and 5 post-traumatic kyphosis patients. There were 7 males and 36 females, with an average age of 64.0±3.5 years(range, 60.0-73.0 years). Scoliosis Research Society(SRS)-22, Oswestry disability index(ODI) questionnaires and visual analog scale(VAS) for back and leg pain were used to evaluate the quality of life of the adult deformity patients over 60 years old. Spinopelvic parameters were measured on standing lateral full-spine radiographs, including sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS) and T1 pelvic angle(TPA). In addition, the values of PI-LL were calculated. Pearson correlation was used to evaluate the relationships of sagittal parameters and quality of life in the adult deformity patients over 60 years old. Results: The scores of function, pain, self-image, mental health, and sub-total in the SRS-22 questionnaire were 13.4±2.1, 17.3±2.7, 13.2±3.0, 15.7±11.8 and 59.6±5.6 respectively. The average scores of ODI, VAS back and VAS leg were (46.8±17.8)%, 5.7±2.6 and 3.9±3.0 respectively. The mean values of SVA, TK, LL, PI, PT, SS, TPA and PI-LL were 6.5±6.2cm, 12.7°±15.8°, -16.9°±17.2°, 49.0°±12.3°, 30.2°±11.6°, 18.8°±10.6°, 28.8°±14.4° and 32.1°±17.8° respectively. Pearson correlation analysis showed SVA and TPA correlated with the score of function, pain, self-image, sub-score of SRS-22, ODI, VAS back pain(r=-0.386, -0.375, -0.361, -0.410, 0.445, 0.389, P<0.05; r=-0.403, -0.426, -0.466, -0.425, 0.512, 0.465 respectively, P<0.05). LL, PT and PI-LL were correlated with ODI and VAS back pain(r=0.368, 0.367, P<0.05; r=0.376, 0.341, P<0.05; r=0.401, 0.395, P<0.05 respectively). However, TK, PI, and SS showed no correlated with health related quality of life（P>0.05）. Conclusions: In the adult deformity patients over 60 years old, increased SVA and TPA can affect the function, self-image and back pain. Decreased LL, increased PT and increased PI-LL can aggravate the back pain of patients. TPA can both represent the sagittal alignment of spine and pelvis, which is correlated most strongly with the quality of life in patients.