成人特发性脊柱侧凸患者脊柱-骨盆矢状位平衡分析

Analysis of spinopelvic sagittal alignment in adult patients with idiopathic scoliosis

中文关键词:  特发性脊柱侧凸  脊柱  骨盆  矢状位平衡  成人

英文关键词:Idiopathic scoliosis  Spine  Pelvic  Sagittal balance  Adult

中文摘要:

  【摘要】　目的：分析不同类型成人特发性脊柱侧凸（IS）患者的脊柱-骨盆矢状位平衡情况。方法：回顾分析2002年4月~2009年4月收治的83例成人IS患者，男16例，女67例，年龄20~84岁，平均43岁。在全脊柱站立位X线正侧位片（包括双侧髋关节）上测量侧凸Cobb角、胸椎后凸角（TK）、胸腰段后凸角（TLJ）、腰椎前凸角（LL）、骨盆入射角（PI）、骶骨倾斜角（SS）、骨盆倾斜角（PT）以及C7铅垂线与S1后上缘的水平距离（SVA）。将患者分为胸弯组和腰弯组，比较两组患者的脊柱-骨盆矢状位参数，分析各参数间的相关性及各参数与年龄的相关性。结果：胸弯组共39例，平均年龄40.9岁，主弯角度平均45.8°；腰弯组共44例，平均年龄44.8岁，主弯角度平均39.5°。两组患者的年龄无统计学差异（P>0.05）。两组的TK、TLJ、LL、PI、SS、PT均无统计学差异（P>0.05），但腰弯组的SVA明显大于胸弯组（P＜0.05）。在≤40岁患者中，胸弯组和腰弯组患者的脊柱-骨盆矢状位序列无统计学差异（P>0.05）；在＞40岁患者中，腰弯组患者SVA和PT大于胸弯组（P＜0.05），余参数两组间无统计学差异（P>0.05）。胸弯组9例（23.1%）出现脊柱失平衡，其中7例为负向失平衡；腰弯组12例（27.3%）出现脊柱失平衡，其中8例为正向失平衡。两组的LL与TK、SS有相关性，PI与PT、SS有相关性，SVA与LL、SS、PT有相关性，年龄与SVA、PT有相关性。与胸弯组不同，腰弯组患者的PI与LL无相关性，而年龄与LL、SS有相关性，PT与LL、SS有相关性。结论：成人IS中，胸弯和腰弯患者的骨盆形态无差别，骨盆与脊柱的矢状位序列密切相关，年龄与躯干平衡相关。胸弯患者易出现脊柱负向失平衡，而腰弯患者更易出现脊柱正向失平衡。

英文摘要:

  【Abstract】 Objective：To analyze the spinopelvic sagittal alignment in adult patients with idiopathic scoliosis according to curve types.Method：The sagittal spinopelvic parameters and scoliosis curves types were analyzed retrospectively in standing radiographs of 83 adult patients（mean age 43.0 years） with adult idiopathic scoliosis，these parameters included cobb angle of primary scoliosis，thoracic kyphosis（TK），thoracolumbar junction kyphosis（TLJ），lumbar lordosis（LL），pelvic incidence（PI），sacrum slope（SS），pelvic tilt（PT） and sagittal vertical axis（SVA）.According to SRS classification，the patients were divided into two groups，thoracic curve and lumbar curve.All spinopelvic parameters between two groups were compared.The correlations between parameters as well as these parameters with age were analyzed.Result：The average age of 39 patients with thoracic curve was 40.9，while that for 44 patients with lumbar curve was 45.8.No age-related difference was noted between two groups.Also no difference for all spinopelvic parameters except SVA was noted.The SVA in patients with lumbar curve was significantly greater than that with thoracic curve（P＜0.05）.For patients less than 40 years old，all spinopelvic parameters between two groups showed no difference，while for patients older than 40 years old，SVA and PT in lumbar curve group were significant greater than those in thoracic curve group（P＜0.05）.In thoracic curve group，9 patients had SVA more than±50mm.Among them 7 patients were negative imbalance.In lumbar curve group，12 patients had SVA more than±50mm，and 8 patients of them were positive imbalance.In both two groups，there were significant correlations between LL and TK，LL and SS，PI and SS，PI and PT，SVA and LL，SVA and SS，SVA and PT，age and SVA，and age and PT.PI showed significant correlaion with LL in patients with thoracic curve while no correlation with LL in patients with lumbar curve.Unlike thoracic curve group，no relationship between PI and LL in lumbar curve group were noted，while there were significant correlations between age and LL，age and SS，PT and LL，and PT and SS.Conclusion：In adult patients with idiopathic scoliosis，there is no difference with respect to pelvic shape between thoracic and lumbar curves，and the pelvic is related to alignment of spine sagittal plane，age is related the imbalance of spine.Thoracic curve is apt to lead to negative imbalance，while lumbar curve is apt to lead to positive imbalance.