退变性腰椎侧凸脊柱-骨盆矢状位影像学特点

Radiographic characteristics of sagittal spino-pelvic alignment in degenerative lumbar scoliosis

中文关键词:  退变性腰椎侧凸  脊柱  骨盆  矢状位

英文关键词:Degenerative lumbar scoliosis  Spine  Pelvis  Sagittal plane

中文摘要:

  【摘要】 目的：观察退变性腰椎侧凸（DLS）患者脊柱-骨盆矢状位影像学特点，探讨脊柱-骨盆矢状位参数变化对DLS发生的影响。方法：回顾性分析103例DLS患者术前资料，男36例，女67例，年龄62.6±7.4（43~78）岁，并选取139例正常青年人群作为正常青年对照组，145例单纯颈椎病患者作为成年对照组，在脊柱全长正侧位X线片上测量各组冠状位、矢状位参数，包括L3倾斜角、侧凸Cobb角、冠状位平衡（CVA）、腰椎前凸角（LL）、矢状位平衡（SVA）、胸椎后凸角（TK）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）等，采用独立样本t检验比较DLS组与两对照组的各矢状位参数，并用Pearson相关分析DLS组各参数间相关性。结果：DLS组PI为50.4°±10.2°，显著高于正常青年对照组（45.1°±9.6°，P<0.01）和成年对照组（46.9°±9.1°，P<0.01）。与青年及成年对照组相比，DLS组LL、SS较小（P<0.01），PT、SVA较大(P<0.01)；TK小于成年对照组(P<0.01)。DLS组中合并退变性腰椎滑脱者37例（占35.9%），PI为53.1°±8.8°；无退变性腰椎滑脱者66例，PI为48.9°±10.6°，二者相比有统计学差异且均显著高于正常青年对照组（P<0.05）。DLS组侧凸Cobb角与PT显著相关（P <0.05），余冠状位参数与矢状位参数间未发现相关性；LL、PI、SS、PT两两之间显著相关（P<0.01），LL、PT与TK显著相关（P<0.01），SS与TK显著相关（P<0.05），LL与SVA显著相关（P<0.01）。结论：DLS患者PI高于正常青年及颈椎病患者，高PI可能参与了DLS的发病机制；DLS患者退变、侧凸的腰椎仍存在调节矢状位平衡的能力。

英文摘要:

  【Abstract】 Objectives： To study the radiographic characteristics of sagittal spino-pelvic morphology in degenerative lumbar scoliosis(DLS) and its significance in the pathogenesis of DLS. Methods： This was a retrospective analysis of 103 cases(36 males and 67 females) with DLS, all cases had a mean age of 62.6±7.4 years(43-78 yr); the control group included 139 cases of asymptomatic young volunteers; another control group included 145 cases with cervical spondylosis. The coronal and sagittal parameters of DLS group and the corresponding parameters of the two control groups on anteroposterior and lateral radiograph of the whole spine were measured. L3 tilt, Cobb′s angle, coronal vertical axis(CVA), lumbar lordosis(LL), sagittal vertical axis(SVA), thoracic kyphosis(TK), pelvic incidence(PI), pelvic tilt(PT) and sacral slope(SS) were included. The sagittal parameters in DLS group were compared with those in the two control groups by using independent-sample Student′s t test, and the correlations of the parameters in DLS group were analyzed by using Pearson coefficients. Results: The average PI of DLS group was 50.4°±10.2°, which was significantly higher than that of the control group of aymptomatic young adults(45.1°±9.6°, P<0.01) and the control group of cervical spondylosis(46.9°±9.1°, P<0.01). The DLS group had lower LL and SS(P<0.01), higher PT and SVA(P<0.01) than the two control groups, and lower TK than the cervical spondylosisi group. In DLS group, there were 37 patients complicated with degenerative lumbar spondylolisthesis, accounting for 35.9%, and the average PI was 53.1°±8.8°, while the other 66 cases without degenerative spondylolisthesis had an average PI of 48.9°±10.6°. The PI of them had a significant difference and was significantly higher than that in asymptomatic young adults(P<0.05). There were significant correlations between scoliosis Cobb′s angle and PT(P<0.05), while no correlation was found between other coronal parameters and the sagittal parameters. Significant pairwise correlations were found among LL, PI, SS and PT(P<0.01), LL and PT were correlated with TK(P<0.01), SS was also correlated with TK(P<0.05), and LL was correlated with SVA(P<0.01). Conclusions: DLS patients have a higher PI than normal young adults and cervical spondylosis patients, and a higher PI may participate in the pathogenesis of DLS. Lumbar spine in DLS remains ability of regulating the sagittal spino-pelvic balance.