T1骨盆角与退变性脊柱侧凸患者脊柱-骨盆矢状面平衡以及生活质量的相关性分析

Correlations between T1 pelvic angle and spino-pelvic sagittal alignment and health related life quality in patients with degenerative scoliosis

中文关键词:  退变性脊柱侧凸  脊柱-骨盆矢状面平衡  T1骨盆角  生活质量

英文关键词:Degenerative scoliosis  Spino-pelvic sagittal balance  T1 pelvic angle  Health related quality of life

中文摘要:

  【摘要】 目的：探讨T1骨盆角（T1 pelvic angle，TPA）能否反映退变性脊柱侧凸（degenerative scoliosis，DS）患者脊柱-骨盆矢状面的整体及局部平衡，及其与DS患者生活质量的关系。方法：回顾性分析2007年2月~2011年12月在我院接受手术治疗的DS患者资料。纳入标准：（1）随访时间超过2年；（2）有完整临床及影像学资料。排除标准：（1）既往接受过脊柱手术；（2）同时伴有髋、膝关节病变影响正常的站立姿势。共76例DS患者纳入研究，男9例，女67例，年龄45~72岁，平均58.2±6.1岁。Cobb角32°~74°，平均42.6°±6.1°。顶椎位于L2椎体3例，L2/3椎间盘4例，L3椎体26例，L3/4椎间盘23例，L4椎体16例，L4/5椎间盘4例。随访2.1~6.4年，平均3.7年。术前及末次随访时均摄自然站立位全脊柱正、侧位X线片，同时填写ODI、VAS及SRS-22量表。测量胸椎后凸角（thoracic kyphosis，TK）、胸腰段后凸角（thoracolumbar kyphosis，TLK）、腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）、矢状面平衡（sagittal vertical axis，SVA）和TPA。采用Spearman检验分别对术前、末次随访时的SVA和TPA与其他术前、末次随访时的脊柱-骨盆参数作相关性分析，同时分析SVA和TPA术前、末次随访时的变化值与其他脊柱-骨盆参数术前、末次随访时的变化值的相关性。分析SVA和TPA术前、末次随访时的变化值与ODI、VAS及SRS-22总分术前、末次随访时的变化值的相关性。结果：术前TPA与术前LL、SS、PT、PI及SVA显著相关（P<0.05），与术前TK、TLK无相关性（P＞0.05）；末次随访时TPA均与末次随访时的LL、SS、PT、PI及SVA显著相关（P<0.05），与末次随访时TK、TLK无相关性（P＞0.05）；TPA术前、末次随访时的变化值与LL、SS、PT、PI及SVA术前、末次随访时的变化值显著相关（P<0.05），与TK、TLK的变化值无相关性（P＞0.05）；TPA术前、末次随访时的变化值与ODI评分、VAS评分术前、末次随访时的变化值正相关（P<0.05），与SRS-22总分变化值负相关（P<0.05）。术前SVA与术前LL、TPA显著相关（P<0.05），与术前TK、TLK、SS、PT、PI无相关性（P>0.05）；末次随访时SVA与末次随访时TPA显著相关（P<0.05），与末次随访时TK、TLK、SS、PT、PI、LL无相关性（P>0.05）；SVA术前、末次随访时的变化值与LL、TPA术前、末次随访时的变化值显著相关（P<0.05）,与TK、TLK、SS、PT术前、末次随访时的变化值无相关性（P>0.05）；SVA术前、末次随访时的变化值与ODI评分、VAS评分术前、末次随访时的变化值正相关（P<0.05），与SRS-22总分变化值负相关（P<0.05）。结论：TPA整合了整体和局部脊柱-骨盆矢状面平衡的信息，能够反映DS患者脊柱-骨盆矢状面的整体及局部平衡，且与DS患者的生活质量密切相关，对于DS重建手术有着重要的指导意义。

英文摘要:

  【Abstract】　Objectives: To investigate whether T1 pelvic angle(TPA) can represent sagittal balance, and to investigate the relationship between TPA and health related quality of life(HRQOL) of patients with degenerative scoliosis(DS). Methods: Patients with DS who received surgery from February 2007 to December 2011 wereretrospectively reviewed. Inclusion criteria were as followings: having follow-ups longer than 2 years and the complete radiographic and clinical data. Patients were excluded when they had received spinal surgery or suffered from hip or knee disease. A total of 76 DS patients(male: 9; female: 67) was included with an average age of 58.2±6.1 years(range: 45-72 years) and an average Cobb angle of 42.6°±6.1°(range: 32°-74°). Four patients had apical vertebrae at L2, 4 at L2/3 disc, 26 at L3, 23 at L3/4 disc, 16 at L4 and 4 at L4/5 disc. The sagittal alignment parameters were measured on both preoperative and last follow-up radiographs, including thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), sagittal vertical axis(SVA) and TPA. Oswestry disability index(ODI), visual analog scale(VAS) and SRS-22 questionnaire were completed by the patients before surgery and at the last follow-up. Spearman′s rank correlation coefficient was used to determine correlations between preoperative and last follow-up SVA and other spino-pelvic parameters, and so as TPA. Correlations between the changes of TPA and the changes of other parameters and overall ODI scores, VAS and SRS-22 total scores were also analyzed. Results: Preoperative and last follow-up TPAs were significantly related to the preoperative and last follow-up LL, PT, SS, PI, and SVA(P<0.05), but not to TK and TLK(P>0.05). The changes of TPA were significantly related to the changes of LL, PT, SS and SVA(P<0.05), but not to TK and TLK(P>0.05). Moreover, the changes of TPA were also significantly related to the changes of ODI(P<0.05), VAS (P<0.05) and SRS-22 total scores(P<0.05). Preoperative SVA was significantly related to the preoperative LL and TPA(P<0.05), but not to TK, TLK, SS, PT and PI(P>0.05). The last follow-up SVA was significantly related to the last follow-up TPA(P<0.05), but not to TK, TLK, LL, SS, PT and PI(P>0.05). The changes of SVA were significantly related to the changes of LL and TPA(P<0.05), but not to TK, TLK, SS and PT(P>0.05). The changes of SVA were also significantly related to the changes of ODI(P<0.05), VAS(P<0.05) and SRS-22 total scores(P<0.05). Conclusions: TPA can better reflect spino-pelvic sagittal alignment and HRQOL for patients with degenerative scoliosis. which can be served as a reference parameter in surgical planning.