T1骨盆角在脊柱矢状面平衡中的研究进展

Advancement in study of the application of T1 pelvic angle in evaluating global spinal sagittal balance

中文关键词:  脊髓型颈椎病  信度分析  SF-36量表  改良日本骨科协会评分法

英文关键词:Cervical spondylotic myelopathy  Reliability  SF-36  modified Japanese Orthopaedic Association

中文摘要:

  随着中国人口的老龄化，成人脊柱畸形越来越受到人们的关注，脊柱矢状面平衡也成为近年来研究的热点。既往研究报道了大量广泛应用的评估矢状面脊柱骨盆序列的参数，如：矢状面垂直轴（sagittal vertical axis，SVA）、骨盆倾斜角（pelvic tilt，PT）、骨盆入射角与腰椎前凸角匹配程度（pelvic incidence minus lumbar lordosis，PI-LL）等。但是上述参数均易受到骨盆旋转、膝关节屈曲等代偿活动的影响；还易因为使用辅助站立工具而发生改变。影像学检查过程中的投射角度、距离也会对脊柱骨盆参数的测量结果产生影响。大量研究表明，脊柱和骨盆在矢状面畸形的评估、诊疗计划和预后评估方面共同发挥着作用。既往矢状面参数分为两类，一类是脊柱参数，如SVA、腰椎前凸角（lumbar lordosis，LL）等，未能考虑骨盆代偿性后倾；另一类是骨盆参数，如PT、骶骨倾斜角（sacrum slope，SS）等，未能考虑脊柱整体平衡。因此Protopsaltis等提出了T1骨盆角（T1 pelvic angle，TPA），一种新的整体矢状面脊柱骨盆参数，它不仅不受患者体位变化等代偿因素以及影像学测量方法的影响，而且同时考虑脊柱倾斜和骨盆旋转的影响。此方法能将TPA分为脊柱倾斜和骨盆旋转进行分析，通过双侧股骨头连线的中心做垂线，可将TPA分为T1脊柱骨盆倾斜角（T1 spinopelvic inclination，T1SPi）和PT两部分，其几何关系为TPA=T1SPi+PT。随着对TPA研究的深入，有学者尝试通过TPA找到脊柱矢状面平衡与脊柱疾病之间的内在联系，为脊柱疾病的诊疗及预后评估提供更好的参考指标。笔者就近年来TPA在脊柱疾病诊治中的应用的相关研究进行回顾总结。

英文摘要:

  【Abstract】 Objectives: To calculate the reliability of SF-36 and to verify its consistency with neurological function assessment after surgery for Chinese cervical spondylotic myelopathy(CSM) patients. Methods: The data of 142 CSM patients (male=84, female=58, average age was 60.0 years old, SD=10.9) who underwent surgical treatment were prospectively collected. Both neurological measurement (modified Japanese Orthopaedic Association, mJOA score) and quality of life (QOL) measurement (SF-36) were used to evaluate patients in this study preoperatively and at the follow-up of 3-month, 1-year and over 2-year postoperatively. The results of SF-36 evaluation in CSM patients were compared with that of healthy adults. Cronbach α was used to assess the reliability of 8 domains of SF-36. We also analyzed the consistency of domains of SF-36 with mJOA score at different follow-up time points. Based on the changing trends of each scale, we calculated the peak recovery time of CSM patients during the follow-up period. Results: The scores for all SF-36 domains except for mental health domain indicated that patients with CSM were significantly impaired compared with healthy adults. Cronbach α ranged from 0.73 (for role-emotional) to 0.85 (for physical functioning). (Cronbach α: physical functioning=0.85, role-physical=0.83, bodily pain=0.80, general health=0.81, vitality=0.81, social functioning=0.79, role-emotional=0.73, mental health=0.75). At the 3-month follow-up, improvements in mJOA scores were only significantly correlated with the patient′s scores of physical functioning and bodily pain. [Correlation coefficient(CC)(R): physical functioning=0.32, bodily pain=0.20; P<0.05]. At 1 year after surgery, improvements in mJOA scores were significantly correlated with physical functioning, general health, social functioning and role-emotional [CC(R): physical functioning=0.39, general health=0.24, social functioning=0.22, role-emotional=0.19; P<0.05]. While at final follow-up, improvements in mJOA scores were significantly correlated with physical functioning, vitality and role-emotional [CC(R): physical functioning=0.38, vitality=0.20, role-emotional=0.20; P<0.05]. The physical component score(PCS) peaked at 17.7 months and the mental component score(MCS) at 18.9 months, respectively. Conclusions: SF-36 is a reliable method to evaluate patients with CSM. The evaluation of quality of life was inconsistent with the neurological function improvement in different stages of the postoperative follow-up. At the early stage of recovery, the improvements in mJOA scores essentially correlated with domains from the physical components of the SF-36, while at later stages the improvements were associated with domains from both physical and mental components.