中老年人从站立位到坐位的脊柱矢状位序列变化

The changes in sagittal alignment of spine from standing to sitting position in elderly people

中文关键词:  矢状位序列  坐位改变  中老年人

英文关键词:Sagittal alignment  Position change  Elder persons

中文摘要:

  【摘要】 目的：探究中老年人脊柱矢状位序列从站立位到坐位的变化，比较中老年人与青年人在体位改变时矢状位序列的变化差异。方法：回顾性分析在北京大学第三医院行健康检查的53例中老年人资料[男性17人，女性36人，年龄60.7±9.3（45~81）岁]和145例青年人资料[男性51人，女性94人，年龄23.1±2.3（19~29）岁]。所有人均有站立位和坐位时的全脊柱X线检查结果，通过院内影像归档与通信（PACS）系统，测量骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）、胸椎后凸角（TK）、脊柱骶骨角（SSA）、腰椎倾斜角（LT）、脊柱矢状轴（SVA）、T1骨盆角（TPA）等参数。采用配对样本t检验比较中老年组站立位-坐位时矢状位序列的不同，通过独立样本t检验比较中老年组与青年组从站立位到坐位时矢状位序列变化。结果：中老年组站立位SVA为3.9±27.7mm，TPA为8.5°±6.9°，PT为12.7°±7.2°，SSA为124.3°±9.0°，LL为47.2°±12.1°，LT为-6.0°±6.9°，TK为33.2°±8.7°，SS为32.8°±8.2°，坐位时SVA为25.9±26.0mm，TPA为18.1°±8.5°，PT为21.1°±9.5°，SSA为113.6°±10.3°，LL为33.8°±12.9°，LT为-4.4°±5.7°，TK为28.5°±9.7°，SS为25.1°±9.2°，除LT外均存在统计学差异（P<0.05）。站立位到坐位时，其SVA增加22.0±32.6mm，TPA增加9.6°±6.2°，PT增加8.4°±7.3°，LT增加1.5°±6.2°，LL减小13.4°±8.8°，TK减小4.6°±5.0°，SS减少7.6°±7.2°，SSA减小10.7°±8.1°，变化程度均小于青年组（P<0.05）。结论：中老年人从站立位到坐位脊柱-骨盆矢状位形态表现为骨盆后倾，脊柱生理曲度变浅，矢状轴前移，脊柱-骨盆矢状位序列受体位影响变化程度明显小于青年人。

英文摘要:

  【Abstract】 Objectives: To explore how the sagittal alignment of spine change in elderly people from standing position to sitting position and compare these changes with that of normal young Chinese adults. Methods: The data of 53 elder persons(17 males, 36 females; mean age, 60.7±9.3 years) and 145 young adults (51 males, 94 females; mean age, 23.1±2.3 years) that underwent physical examination in Peking University Third Hospital were retrospective reviewed. All of them underwent the full-spine X-ray scan in standing and sitting position. Pelvic and spinal parameters were measured by Picture Archiving and Communication System, including pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), thoracic kyphosis(TK), spinosacral angle(SSA), lordosis tilt(LT), sagittal vertical axis(SVA) and T1-pelvic angle(T1PA). The parameters in different positions were compared using paired t test, and the changes from standing to sitting between elder persons and young adults were compared using independent t test. Results: For elder persons, SVA was 3.9±27.7mm in standing position. TPA, PT, SSA, LL, LT, TK and SS was 8.5°±6.9°, 12.7°±7.2°, 124.3°±9.0°, 47.2°±12.1°, -6.0°±6.9°, 33.2°±8.7° and 32.8°±8.2°, respectively. While in sitting position, SVA was 25.9±26.0mm, TPA, PT, SSA, LL, LT, TK and SS was 18.1°±8.5°, 21.1°±9.5°, 113.6°±10.3°, 33.8°±12.9°, -4.4°±5.7°, 28.5°±9.7° and 25.1°±9.2°, respectively. There were statistical differences(P<0.05) except LT. Changing from standing position to sitting position, SVA increased 22.0±32.6mm, TPA, PT and LT increased 9.6°±6.2°, 8.4°±7.3° and 1.5°±6.2°, respectively; LL, TK, SS and SSA decreased 13.4°±8.8°, 4.6°±5.0°, 7.6°±7.2° and 10.7°±8.1°, respectively. Compared with the young adults, elder persons showed smaller increase in SVA, TPA, PT, LT and smaller decrease in LL, TK, SS when moving from standing to sitting position. Conclusions: When changing from standing position to sitting position, the spine of elder persons went forwards, accompanied with straighter sagittal curve, pelvic retroversion and kyphosis, yet their spine-pelvic sagittal alignment was significantly less affected by body position than young adults.