退变性脊柱侧凸患者脊柱-骨盆矢状位特点及各参数间的相关性分析

Characteristics of sagittal spinal and pelvic parameters in degenerative lumbar scoliosis and it′s correlation analysis

中文关键词:  退变性脊柱侧凸  脊柱-骨盆矢状位平衡  代偿作用

英文关键词:Degenerative lumbar scoliosis  Sagittal spinal and pelvic balance  Compensatory effect

中文摘要:

  【摘要】 目的：分析退变性脊柱侧凸患者脊柱-骨盆矢状位平衡情况及各矢状位参数之间的相关性。方法：选取86例退变性脊柱侧凸患者，以侧凸角度的均数作为分组依据，分为轻度侧凸组（Cobb角＜34°）和重度侧凸组（Cobb角≥34°），选取40例同年龄段健康体检者作为对照组，三组年龄及性别组成相匹配。测量并比较三组的脊柱矢状位参数：胸椎后凸角（TK）、腰椎前凸角（LL）、C7铅垂线与骶骨后上角的水平距离（SVA），骨盆矢状位参数：骨盆指数（PI）、骶骨倾斜角（SS）、骨盆倾斜角（PT）。采用Pearson相关性检验判断脊柱-骨盆矢状位参数间的相关性。结果：对照组与轻度侧凸组、重度侧凸组之间PI无统计学差异（F=0.915，Ｐ=0.403）。三组之间TK、LL、SVA、PT及SS存在着统计学差异，多重比较检验结果显示：（1）重度侧凸组LL小于轻度侧凸组和对照组，轻度侧凸组小于对照组（Ｐ<0.05）；（2）重度侧凸组和轻度侧凸组TK小于对照组（Ｐ<0.05），重度侧凸组和轻度侧凸组之间无差异（Ｐ>0.05）；（3）重度侧凸组和轻度侧凸组SVA大于对照组（Ｐ<0.05），重度侧凸组和轻度侧凸组之间无差异（Ｐ>0.05）；（4）重度侧凸组PT大于轻度侧凸组和对照组，轻度侧凸组大于对照组（Ｐ<0.05）；（5）重度侧凸组SS小于轻度侧凸组和对照组，轻度侧凸组小于对照组（Ｐ<0.05）。相关性分析显示：对照组PI与PT、SS、TK及LL相关，SS与LL相关，TK与LL相关（Ｐ<0.05）；轻度侧凸组PI与PT、SS及LL相关，SS与LL相关，LL与SVA、Cobb角负相关（Ｐ<0.05）；重度侧凸组PI与PT、SS及LL相关，SS与LL相关，SS与Cobb角负相关，LL与SVA、Cobb角负相关（Ｐ<0.05）。结论：退变性脊柱侧凸引起的脊柱-骨盆矢状位参数变化主要为胸椎后凸、腰椎前凸、骶骨倾斜角的减小和SVA、骨盆倾斜角的增大，骨盆指数并无显著性变化。

英文摘要:

  【Abstract】 Objectives: To study the characteristics of sagittal spinal and pelvic parameters in degenerative lumbar scoliosis and correlations among the parameters. Methods: Eighty-six cases with degenerative lumbar scoliosis were divided into mild scoliosis group(Cobb angle ＜34°) and severe scoliosis group(Cobb angle ≥34°), and forty cases of healthy participants were selected as control group. Sagittal parameters of thoracic kyphosis(TK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT) were measured and compared among three groups. Pearson correlation test was used to explore the correlations among parameters. Results: No difference in PI(F=0.915, Ｐ=0.403) was noted among three groups, but significant differences existed in LL, SVA, PT, SS. Analysis of variance(ANOVA) test showed that (1)LL in severe scoliosis group was smaller than that in mild scoliosis group, LL in mild scoliosis group was smaller than that in control group(Ｐ<0.05); (2)TK in severe scoliosis group and mild scoliosis group was smaller than that in control group(Ｐ<0.05), no difference between severe scoliosis group and mild scoliosis group existed(Ｐ>0.05); (3)SVA in severe scoliosis group and mild scoliosis group was bigger than that in control group(Ｐ<0.05), no difference between severe scoliosis group and mild scoliosis group existed(Ｐ>0.05); (4)PT in severe scoliosis group was bigger than that in mild scoliosis group, LL in mild scoliosis group was bigger than that in control group(Ｐ<0.05); (5)SS in severe scoliosis group was smaller than that in mild scoliosis group, LL in mild scoliosis group was smaller than that in control group(Ｐ<0.05). Correlation analysis showed that in control group, PI was positively correlated to PT, SS, TK and LL, SS was positively correlated to LL, TK was positively correlated to LL(Ｐ<0.05); in mild scoliosis group, PI was positively correlated to PT, SS and LL, SS was positively correlated to LL, LL was negatively correlated to SVA and Cobb angle(Ｐ<0.05); in severe scoliosis group, PI was positively correlated to PT, SS and LL, SS was positively correlated to LL, SS was negatively correlated to Cobb angle, LL was negatively correlated to SVA and Cobb angle(Ｐ<0.05). Conclusions: The degenerative lumbar scoliosis patients demonstrate a significant decrease of thoracic kyphosis, lumbar lordosis, sacral slope and increase of SVA, pelvic tilt without change in pelvic incidence.