不同弯型青少年特发性脊柱侧凸患者脊柱-骨盆矢状面参数研究

Sagittal spinopelvic alignment in various curve patterns in adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  脊柱-骨盆矢状面  颈椎角  弯型

英文关键词:Adolescent idiopathic scoliosis  Sagittal spinopelvic alignment  Cervical sagittal angle  Curve type

中文摘要:

  【摘要】 目的：探讨不同弯型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者脊柱-骨盆矢状面平衡情况。方法：回顾性分析2013年9月～2014年12月我科收治的161例AIS患者，其中男34例，女127例，年龄12～17岁（14.6±2.1岁）。在术前站立位全脊柱正侧位X线片上测量主弯Cobb角、颈椎角（cervical sagittal alignment，CSA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacrum slope，SS）以及C7铅垂线与S1后上缘的水平距离（sagittal vertical axis，SVA）。根据不同弯型将AIS患者分为单胸弯组、双胸弯组和腰弯组，比较3组间脊柱-骨盆矢状位参数的差异，采用Pearson相关性分析对各参数间的相关性进行分析。结果：单胸弯组61例，其中男13例，女48例，主弯Cobb角为51.2°±8.7°；双胸弯组40例，其中男7例，女33例，主弯Cobb角为53.7°±5.2°；腰弯组60例，男14例，女46例，主弯Cobb角为48.9°±4.8°。3组患者年龄及性别分布均无统计学差异（P＞0.05）。3组间Cobb角大小的差异无统计学意义（P>0.05）。单胸弯组的CSA、TK均显著小于双胸弯和腰弯组（P＜0.05），但后两组间的差异无统计学意义（P>0.05），余各项矢状面参数3组间无统计学差异（P＞0.05）。在3组患者中，CSA与TK均呈显著性正相关（单胸弯组r=0.73，P＜0.05；双胸弯组r=0.29，P＜0.05；腰弯组r=0.60，P＜0.05），但与LL及骨盆参数（PI、SS、PT）无显著相关性（P＞0.05）。双胸弯组TK与LL呈正相关性（r=0.40，P＜0.05），而在另外两组则无相关性（P＞0.05）。结论：单胸弯型AIS患者较双胸弯型和腰弯型患者具有更小的颈椎前凸，3种弯型AIS患者的颈椎前凸均与TK呈正相关。单胸弯型患者的TK较另外两种弯型患者更小。双胸弯型患者的TK与LL密切相关，而单胸弯型与腰弯型患者的TK与LL无关。

英文摘要:

  【Abstract】 Objectives: To compare the sagittal spinopelvic alignment of adolescent idiopathic scoliosis(AIS) patients with various curve patterns. Methods: 161 adolescent idiopathic scoliosis(AIS) patients retrospectively reviewed in our department from September 2013 to December 2014. Among them, there were 34 males and 127 females. The average age was 14.6±2.1 years(range, 12-17 years). Main Cobb angle was obtained from preoperative full-spine standing coronal X-ray film. Sagittal spinal and pelvic parameters were measured from the standing lateral radiograph, including cervical sagittal angle(CSA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence (PI), sacrum slope(SS) and pelvic tilt(PT). According to the various curve types, the patients were classified into single thoracic(ST), double thoracic(DT) and major lumbar(ML) curve groups. The sagittal spinopelvic parameters were analyzed among the 3 groups by using one-way ANOVA. Pearson analysis was used to investigate the relationship among parameters. Results: 61 patients were in the ST group with a mean Cobb angle of 51.2°±8.7°, 40 in the DT group with a mean Cobb angle of 53.7°±5.2°, and 60 in the ML group with a mean Cobb angle of 48.9°±4.8°. There was no significant difference among the 3 groups with regard to sex and age distribution. No significant difference in the magnitude of Cobb angle was observed among the 3 groups(P>0.05). The CSA and TK in the ST group were significantly lower than those in the DT and ML groups(P<0.05), but there was no significant difference between the latter 2 groups(P>0.05). No significant difference was found in the other parameters among the 3 groups(P>0.05). The CSA was correlated with TK in all 3 groups(ST group: r=0.73, P<0.05; DT group: r=0.29, P<0.05; ML group: r=0.60, P<0.05), but not correlated with LL and pelvic parameters(PI, SS and PT). In the DT groups TK was correlated with LL(r=0.40, P<0.05), but no correlation was found in the other groups(P>0.05). Conclusions: The AIS patients with ST curve has a lower CSA than the patients with DT and ML curves, and the CSA is in association with TK in all the 3 curves. The TK is lower in the ST group compared with that in the other groups. Only the TK in the patients with DT curve is correlated with LL, and no correlation is found in the ST and ML curve patients.