重度成人特发性脊柱侧凸脊柱-骨盆矢状面特点分析

Spino-pelvic sagittal alignment analysis in severe adult idiopathic scoliosis

中文关键词:  特发性脊柱侧凸  重度脊柱侧凸  矢状面平衡  骨盆参数  成人

英文关键词:Idiopathic scoliosis  Severe scoliosis  Sagittal balance  Coronal plane  Pelvic alignment

中文摘要:

  【摘要】 目的：探讨重度成人特发性脊柱侧凸患者脊柱-骨盆矢状面平衡特点。方法：本研究纳入79名正常志愿者（正常组）、83例轻中度成人特发性脊柱侧凸患者（Cobb角<60°）以及69例重度成人特发性脊柱侧凸患者（Cobb角>80°），再根据主弯部位分为胸弯组及胸腰弯/腰弯组，测量各组冠状面参数包括主弯Cobb角、冠状面偏移（CB）以及顶椎偏移（AVT），矢状面参数包括矢状面偏移（SVA）、胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）和骶骨倾斜角（SS）、骨盆厚度（PTH）、骶骨股骨距离（SFD）、骶骨骨盆角（PRS1）、PI与LL差值（PI-LL）、PT与PI比值（PT/PI）以及C7铅垂线与骶骨中心距离（HA-C7PL）。比较各组间冠状面及矢状面参数的特点及各参数间的相关性。相关性分析使用Pearson相关分析。不同疾病组同一参数间的对比研究使用单因素方差分析及两两比较q检验。结果：与正常组相比，重度成人特发性脊柱侧凸患者的LL、TLK、TK及PRS1显著增大，PI、PT、PTH、SFD及PI-LL显著减小，重度胸腰弯/腰弯组的SVA显著增大而SS显著减小，但SVA在平衡范围内。正常组与轻中度胸弯组，冠状面及矢状面参数间无相关性。在轻中度胸腰弯/腰弯组、重度胸弯组及重度胸腰弯/腰弯组，Cobb角与TK、TLK具有相关性。在所有组中，LL与TK、LL与TLK、PI与PT及PI与SS均具有相关性。在正常组、重度胸弯组及重度胸腰弯/腰弯组中，TK与TLK具有相关性。轻中度胸腰弯/腰弯组CB与PT具有相关性；重度胸弯组中，CB与TLK、SS具有相关性；重度胸腰弯/腰弯组，冠状面Cobb角与LL及CB与PT、SS具有相关性。在重度胸腰弯/腰弯组中，LL与SVA具有相关性。在重度脊柱侧凸组中，TK与SVA具有相关性。结论：重度成人特发性脊柱侧凸矢状面排列具有自身特点，表现为TK、TLK、LL的显著增大与PI、PT的显著减小；冠状面参数中冠状面主弯Cobb角与TK、TLK及CB与SS均具有相关性，矢状面参数中TK、TLK与LL三者之间及TK与SVA之间均具有相关性；骨盆发生明显的形态学改变，表现为狭长水平的形态。

英文摘要:

  【Abstract】 Objectives: To investigate the spino-pelvic sagittal alignement characters of severe scoliosis. Methods: A total of 79 asymptomatic volunteers(normal group), 83 mild scoliosis and 69 severe scoliosis patients were recruited in this series. The following coronal and sagittal parameters were measured: (1)Coronal alignments: coronal Cobb angle of the main curve, coronal balance(CB) and apical vertebral translation(AVT); (2)Sagittal alignments: thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), sagittal vertical axis(SVA), pelvic thickness(PTH), sacral femoral distance(SFD), sacral pelvic angle(PRS1), PI minus LL(PI-LL), ratio of PT and PI(PT/PI) and the distance between hip axis and C7PL(HA-C7PL). Correlations of the parameters between two groups were determined by using the Pearson correlation coefficient. Comparison of the values for the same parameters in different groups was done with a one-way ANOVA and rank-sum test. Results: Compared to normal group, in severe scoliosis, LL, TLK, TK and PRS1 increased significantly, PI, PT, PTH, SFD and PI-LL decreased significantly;while SVA(within normal range) increased significantly and SS decreased significantly in thoraco-lumbar/lumbar curve scoliosis. Correlations were absent between coronal parameters and sagittal parameters in normal group and mild thoracic curve scoliosis, while correlation of Cobb angle with TK existed and TLK in the other three groups. Different correlations between CB and sagittal parameters were present in mild thoraco-lumbar/lumbar curve scoliosis and severe scoliosis curves. Correlations were present between LL and TK, LL and TLK, PI and PT, PI and SS. Correlation between TK and TLK was present in normal group and severe scoliosis patients. Correlation between TK and SVA was only present in severe scoliosis patients. Correlation between LL and SVA was only present in thoraco-lumbar/lumbar curve scoliosis. Conclusions: Increased TK, TLK, LL and decreased PI, PT are common in severe scoliosis, and severe scoliosis patients tend to have a narrow and horizontal shape pelvis.