汉族成人特发性脊柱侧凸患者与正常人群矢状面形态比较

Comparison of the sagittal morphology in adult idiopathic scoliosis with age-matched healthy adults in Chinese Han population

中文关键词:  成人特发性脊柱侧凸  骨盆形态  矢状面平衡

英文关键词:Adult idiopathic scoliosis  Pelvic morphology  Sagittal balance

中文摘要:

  【摘要】 目的：比较汉族人群中成人特发性脊柱侧凸（idiopathic scoliosis，IS）患者与正常人群间的脊柱骨盆矢状面形态差异。方法：151例汉族成人IS患者及65例年龄匹配的健康志愿者被纳入本研究。151例成人IS患者中，男25例，女126例；年龄26.4±7.1岁，主弯Cobb角39.5°±16.4°（16°~102°）；单胸弯41例，双胸弯11例，双主弯28例，胸腰弯15例，三主弯3例，腰弯53例。在站立位全脊柱侧位X线片上测量脊柱骨盆矢状面参数，包括骨盆入射角（PI）、胸椎后凸角（TK）、骨盆倾斜角（PT）、腰椎前凸角（LL）、骶骨倾斜角（SS）及胸腰椎交界性后凸角（TJK）。比较成人IS与正常人群间的脊柱骨盆矢状面参数的差异，比较单胸弯与腰弯患者间的脊柱骨盆矢状面参数的差异。用Pearson相关分析法检测各矢状面参数间的相关性。结果：成人IS患者与正常人群相比，PI（46.3°±10.6°与46.0°±9.5°，P>0.05）及LL（-53.3°±13.8°与-51.3°±9.0°，P>0.05）大小类似，但前者TK偏小（19.7°±12.9°与27.8°±9.8°，P<0.05），PT偏小（6.4°±8.2°与10.3°±6.3°，P<0.05），而SS偏大（39.8°±8.8°与35.7°±7.2°，P<0.05）。单胸弯及腰弯组IS患者的TK均小于正常人群（P<0.05），而单胸弯、腰弯组间TK无明显差异（P>0.05）；单胸弯、腰弯组IS患者及正常人间的PI均无明显差异（P>0.05）；单胸弯组的TJK小于腰弯组及正常人群（P<0.05）,单胸弯组的LL大于腰弯组（P<0.05），单胸弯组的SS大于正常人群（P<0.05），而单腰弯组的PT小于正常人群（P<0.05）。单胸弯组、腰弯组及正常人群中TK均与LL明显相关（P<0.05），而LL又与PI、SS相关（P<0.05）。单胸弯组及腰弯组中PT与TK、LL明显相关（P<0.05），而正常人群中则无明显相关性（P>0.05）。结论：与正常人群相比，成人IS患者的胸椎后凸偏小，同时骨盆有前旋趋势。PI在汉族成人IS患者与正常人间以及单胸弯与腰弯IS患者间均无差异。

英文摘要:

  【Abstract】 Objectives: To determine the difference of the sagittal morphology in adult idiopathic scoliosis(IS) with age-matched healthy adults in Chinese Han population. Methods: 151 adult patients with idiopathic scoliosis(IS) and 65 healthy age-matched adults were recruited consecutively. Within the 151 patients, there were 25 males and 126 females. The average age of the IS patients was 26.4±7.1 years. The average Cobb angle of the main curve was 39.5°±16.4°(16°-102°). There were 41 cases with single thoracic scoliosis, 11 with double thoracic scoliosis, 28 with double major scoliosis, 15 with thoracolumbar scoliosis, 3 with triple major scoliosis and 53 with lumbar scoliosis. All the parameters were measured on the standing posteroanterior and lateral radiographs. The measured sagittal parameters included thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), sacrum slope(SS), and pelvic tilt(PT). The parameters were compared between IS adults and healthy adults. Analysis of variance was used to compare the sagittal parameters among single thoracic scoliosis group, lumbar scoliosis group and healthy adults group. The associations of all parameters were also analyzed. The correlation between 2 sagittal variables was determined via Pearson correlation coefficient(r). Results: The PI(46.3°±10.6° vs. 46.0°±9.5°, P>0.05) and LL(-53.3°±13.8° vs. -51.3°±9.0°, P>0.05) of adult idiopathic scoliosis patients were comparable with those of healthy persons. The TK(19.7°±12.9° vs. 27.8°±9.8°, P<0.05) and PT(6.4°±8.2° vs. 10.3°±6.3°, P<0.05) of adult idiopathic scoliosis patients were significant smaller than those of the healthy adults. The SS(39.8°±8.8° vs. 35.7°±7.2°, P<0.05) of adult idiopathic scoliosis patients was significant larger than that of the healthy adults. The TK values were comparable(P>0.05) between single thoracic scoliosis patients and lumbar scoliosis patients. The PI values were comparable(P>0.05) among single thoracic scoliosis patients, lumbar scoliosis patients and healthy persons. The TJK of single thoracic scoliosis patients was smaller than that of lumbar scoliosis and healthy persons(P<0.05). The LL value of single thoracic scoliosis patients was larger than that of lumbar scoliosis(P<0.05). The SS of single thoracic scoliosis patients was larger than that of healthy persons(P<0.05). The PT of lumbar scoliosis patients was smaller than that of healthy persons(P<0.05). The TK was found to be strongly correlated with LL in all the three groups(P<0.05). The LL was associated with PI and SS in all the three groups(P<0.05). The PT was correlated with TK and LL in the single thoracic scoliosis group and lumbar scoliosis group(P<0.05), but not in the control group(P>0.05). Conclusions: Adult idiopathic scoliosis patients have flatter thoracic kyphosis and pronated pelvic compared with normal controls. Adult idiopathic scoliosis in Chinese have similar PI compared with age-matched healthy adults. The pelvic incidence has no difference between single thoracic and lumbar scoliosis group.