青少年腰椎间盘突出症患者脊柱-骨盆矢状面形态的影像学研究

Sagittal spino-pelvic alignment in adolescent patients with lumbar disc herniation

中文关键词:  青少年腰椎间盘突出症  矢状面  脊柱-骨盆参数  骨盆投射角

英文关键词:Adolescent lumbar disc herniation  Sagittal plane  Spino-pelvic parameters  Pelvic incidence

中文摘要:

  【摘要】　目的：评估青少年腰椎间盘突出症（adolescent lumbar disc herniation，ALDH） 患者的矢状面脊柱-骨盆形态，并探讨其与正常青少年间是否存在差异。方法：2006年3月~2012年5月收治ALDH患者30例，其中男18例，女12例，年龄12~18岁，平均16.0±3.1岁。年龄及性别匹配的正常青少年40例作为对照组，其中男24例，女16例，年龄13~18岁，平均16.6±2.1岁。在站立位全脊柱侧位X线片上测量胸椎后凸角（thoracic　kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、矢状面平衡（sagittal vertical axis，SVA）、骨盆投射角 （pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）和骶骨倾斜角（sacral slope，SS），并对两组间的上述影像学指标进行比较分析。结果：两组年龄及性别比无统计学差异（P＞0.05）。ALDH组矢状面TK（9.1°±7.0°）、LL（22.5°±12.2°）和SS（20.2°±6.2°）均显著小于正常对照组（分别为24.8°±8.2°、47.8°±9.5°、32.5°±6.7°）（P＜0.05）；ALDH组矢状面PT（21.5°±6.3°）、SVA（-5.0±31.2mm）大于正常对照组（8.9°±7.3°、-18.7±18.6mm）（P＜0.05）；ALDH组PI为41.2°±8.5°，对照组PI为42.2°±7.1°，两组间比较无统计学差异（P＞0.05）。结论：ALDH患者PI值与正常青少年相近。与正常青少年相比，ALDH患者表现出明显的骶骨垂直化、胸椎及腰椎生理曲度减小，这种矢状面异常可能是患者为了缓解疼痛而采取的一种保护性体位所致。

英文摘要:

  【Abstract】　Objectives: To evaluate the sagittal spino-pelvic alignment in adolescent lumbar disc herniation(ALDH) patients compared with normal adolescents. Methods: From March 2006 to May 2012, a total of 30 patients with ALDH， including 18 males and 12 females with the age ranging from 12 to 18 years(averaged 16.0±3.1 years) was reviewed retrospectively. Forty adolescents(24 males and 16 females) with the age ranging from 13 to 18 years(averaged 16.6±2.1 years) were selected as the normal controls. On standing lateral X-ray, the following parameters were measured: thoracic kyphosis(TK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT) and sacral slope(SS). Sagittal spino-pelvic parameters were analyzed and compared between two groups. Results: No significant difference was found between two groups in terms of age and gender ratio(P＞0.05). The average TK(9.1°±7.0°), LL(22.5°±12.2°) and SS(20.2°±6.2°) was smaller in ALDH group than normal controls(TK, 24.8°±8.2°; LL,　47.8°±9.5°; SS, 32.5°±6.7°) respectively(P＜0.05). However, the average PT(21.5°±6.3°) and SVA(-5.0±31.2mm) was higher in ALDH group than normal controls(PT, 8.9°±7.3°; SVA, -18.7±18.6mm)(P＜0.05). There was no significant difference between two groups with respect to PI(41.2°±8.5° in ALDH group, 42.2°±7.1° in controls)(P＞0.05). Conclusions: PI is similar between two groups. The sagittal features, including vertical sacrum, thoracic hypokyphosis and straight lumbar spine might be related to a protective posture for pain relief in ALDH patients.