正常国人脊柱－骨盆矢状位序列拟合关系研究

Radiographic analysis of spino-pelvic sagittal alignment and prediction of lumbar lordosis in Chinese asymptomatic subjects

中文关键词:  骨盆入射角  腰椎前凸角  线性回归

英文关键词:Pelvic incidence  Lumbar lordosis  Linear regression

中文摘要:

  【摘要】 目的：建立国人腰椎前凸角（lumbar lordosis，LL）与骨盆矢状位序列间的拟合关系。方法：采用影像学分析，对171例正常青年志愿者进行影像学研究，男94例，女77例，年龄23.0±1.8岁(18~28岁)。均行全脊柱正侧位X线片检查，利用院内影像归档与通信系统测量脊柱与骨盆矢状位参数，包括骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、LL、胸椎后凸角（thoracic kyphosis，TK）、颈椎前凸角（cervical lordosis，CL）、矢状位平衡（sagittal vertical axis，SVA）。利用Pearson检验进行LL与其他各参数间相关性分析，利用线性回归分析建立LL与其他各参数间线性拟合关系。根据既往研究LL＝PI＋9，以PI测量值为基础，运用配对样本t检验进行LL预测值与实际测量值间对比。结果：PI为44.6°±9.5°，LL为48.4°±10.8°，SS为34.4°±8.0°，TK为24.2°±9.6°，CL为7.9°±9.6°，SVA为－20.5±30.1mm；LL与PI、SS、TK、CL、SVA呈显著相关（P<0.05）。运用多元线性回归分析，LL＝2.958+0.760 SS+0.323 TK+0.198 PI+0.122 CL－0.118 SVA；运用简单线性回归分析，LL＝0.623 PI+20.611。根据既往文献报道LL＝PI+9，以此计算出的LL预测值53.7°±9.5°与实际测量值差异显著（t=7.025，P<10-6）。结论：以PI为自变量的简单线性回归LL＝0.623 PI+20.611能准确估计个体的LL，在西方人群中得到的LL＝PI＋9结果并不适用于国人LL的估计。

英文摘要:

  【Abstract】 Objectives: To investigate a prediction equation of lumbar lordosis from selective spinal and pelvic sagittal parameters in Chinese asymptomatic subjects. Methods: This was a prospective radiological analysis by using full-spine standing lateral radiographs of Chinese volunteers. One hundred seventy-one volunteers[94 males, 77 females; mean age 23.0±1.8 years(range, 18-28 years)] participated in this series. Pelvic and spinal parameters were measured, including pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), thoracic kyphosis(TK), cervical lordosis(CL), sagittal vertical axis(SVA). Pearson correlation test was calculated and a multifactor regression analysis was conducted by using the lumbar lordosis(dependent variable) and the other spinal and pelvic parameters(independent variables) to determine the best sets of predictors. According to a formula proposed by Duval-Beaupere, LL＝PI+9, a paired sample t test was conducted between the predicted and measured values. Results: PI was 44.6°±9.5°, LL was 48.4°±10.8°, SS was 34.4°±8.0°, TK was 24.2°±9.6°, CL was 7.9°±9.6°, SVA was -20.5±30.1mm. LL was significantly correlated with PI, SS, TK, CL and SVA(P<0.05). Based on a multifactor regression analysis, LL predictive equation was LL＝2.958+0.760 SS+0.323 TK+0.198 PI+0.122 CL－0.118 SVA. Only based on PI, predictive equation was LL＝0.623 PI+20.611. According to LL＝PI+9, there was a significant difference between measured and predicted lordosis(t=7.025, P<10-6). Conclusions: Using simple linear regression analysis, LL can be precisely predicted, LL＝0.623 PI+20.611. The formula proposed by Duval-Beaupere(LL＝PI+9) can not be applied in Chinese subjects.