退变性腰椎侧凸患者矢状面平衡的特点及对腰椎侧凸的影响

The characteristics of sagittal balance parameter in degerative lumbar scoliosis and its effect to lumbar scoliosis

中文关键词:  矢状面平衡  腰椎侧凸  椎间盘退变  生活质量

英文关键词:Balance of sagittal plane  Lumbar scoliosis  Intervertebral disc degeneration  The quality of life

中文摘要:

  【摘要】 目的：分析退变性腰椎侧凸矢状面平衡参数的特点及其对腰椎侧凸的影响，探讨矢状面平衡参数改变在退变性腰椎侧凸进展中的作用。方法：回顾分析2012年3月～2017年3月经我院诊治的退变性腰椎侧凸患者（病例组）90例，男37例，女53例，年龄51～77岁（57.1±5.8岁）。选取同时期、同年龄段及同性别比的无腰椎侧凸的55例腰椎退行性疾病患者作为照组（对照组），男31例，女24例，年龄50～76岁（56.8±6.1岁）。所有患者均行脊柱全长X线检查，同时填写Oswestry功能障碍指数（Oswestry disability index，ODI）、视觉模拟评分（visual analogue scale/score，VAS）及脊柱侧凸研究学会22项（scoliosis research society-22，SRS-22）量表。测量矢状面平衡相关参数：（1）脊柱参数，脊柱矢状轴（sagittal vertical axias，SVA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骶骨倾斜角（sacrum slop，SS）；（2）骨盆参数，骨盆入射角（prlbrv incidence，PI）、骨盆倾斜角（pelvic tilt，PT）；（3）脊柱-骨盆参数，T1骨盆角（T1 pelvic angle，TPA）、L1骨盆角（L1 pelvic angle，LPA）。比较两组患者各矢状面平衡参数是否具有统计学差异，分析各矢状面平衡参数与生活质量及腰椎侧凸Cobb角的相关性。结果：两组患者的SVA、TK、PI、PT及TPA差异无统计学意义（P＞0.05）；SS、LL及LPA差异有统计学意义（P＜0.05）。两组患者ODI、VAS及SRS－22差异有统计学意义（P＜0.05）。病例组资料相关性分析显示，ODI、VAS及SRS－2与矢状面平衡参数SS、LL及LPA有显著相关性（-1＜r＜1，P＜0.05），与SVA、TK、PI、PT及TPA无显著相关性（P＞0.05）；侧凸Cobb角与LL呈负相关（-1＜r＜0，P＜0.05）；与SS及LPA均呈正相关（0＜r＜1，P＜0.05）。进一步回归分析显示，侧凸Cobb角与SS、LL及LPA存在直线回归关系（F=417.331，P＜0.01），其回归方程为Cobb角=19.526-8.223×LL＋3.727×SS＋1.618×LPA。结论：退变性腰椎侧凸患者矢状面平衡参数以LL和SS改变为主，表现为LL减小及SS增大并随侧凸的加重而进展，降低了患者的生活质量。

英文摘要:

  【Abstract】 Objectives: To analyze the characteristics of sagittal balance parameter in degenerative lumbar scoliosis and its effects on lumbar scoliosis, and to explore its characteristics and roles in degenerative lumbar scoliosis. Methods: The imaging data of 90 patients who diagnosed primary degenerative lumbar scoliosis in our hospital from March 2012 to March 2017 were retrospectively reviewed as the case group. The imaging data of 55 patients diagnosed as lumbar degenerative diseases excluding lumbar scoliosis were selected as the control group. The two groups were matched with same time period, same age period and same sex ratio and all cases were performed on whole spine X-ray. Oswestry disability index(ODI), visual analog scale(VAS) and SRS-22 questionnaire were completed by the patients. Through software J, the following sagittal balance parameters were measured: sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), T1 spino-pelvic angle(TPA) and L1 spino-pelvic angle(LPA). The sagittal balance parameters were compared in two groups, and the lumbar Cobb angle and the sagittal balance parameter were analyzed. Results: By using paired-t test, the overall balance parameter of sagittal plane(SVA, TK, PI, PT, TPA) between the case and control group had no significant difference(P＞0.05), while the local balance parameter of sagittal plane(SS, LL, LPA) between two groups had significant difference(P＜0.05). ODI, VAS and SRS-22 between two groups had significant difference(P＜0.05). Correlation analysis showed that ODI, VAS and SRS-22 had significant correlation(-1＜r＜1, P＜0.05) with the local balance parameter of sagittal plane(SS, LL, LPA), and had no significant correlation (P＞0.05) with the overall balance parameters of sagittal plane(SVA, TK, PI, PT, TPA). The lumbar Cobb angle was negatively correlated with LL and LPA(-1＜r＜0, P＜0.05) and positively correlated with SS(0＜r＜1, P＜0.05). Further regression analysis showed that there was a linear regression relationship of Cobb angle with SS, LL and LPA (F=417.331, P<0.01), and its regression equation was Cobb angle=19.526-8.223×LL＋3.727×SS＋1.618×LPA. Conclusions: For the degenerrative lumbar scoliosis, the LL and SS are more serious than other sagittal balance parameters and show the decrease of LL and the increase of SS which are worse with the progress of lumbar scoliosis. These changes affect the quality of life of patients.