胸腰椎骨质疏松性椎体压缩骨折患者脊柱-骨盆矢状位参数的研究

The study of sagittal spino-pelvic parameters in thoracolumbar osteoporotic vertebral compression fractures

中文关键词:  椎体压缩性骨折  骨质疏松症  矢状位参数  治疗策略

英文关键词:Vertebral compression fracture  Osteoporosis  Sagittal parameters  Therapeutic strategy

中文摘要:

  【摘要】 目的：分析胸腰椎骨质疏松性椎体压缩骨折（OVCFs）患者脊柱-骨盆矢状位影像学特点，为临床该病的治疗提供理论依据。方法：分析116例胸腰椎OVCFs患者资料（胸腰椎OVCFs组），选取102例骨质疏松症非骨折患者作为单纯骨质疏松对照组（单纯OP组），46例骨量正常健康体检者作为骨量正常对照组（骨量正常组）。统计胸腰椎OVCFs组骨折椎体分布情况。在脊柱全长侧位X线片上测量各组矢状位参数：胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）、矢状位平衡（SVA）、T1骨盆角（TPA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS），并行Oswestry功能障碍指数（Oswestry disability index，ODI）评分问卷调查，分析3组间参数差异及各组内参数间的相关性。以脊柱矢状位平衡判定标准作为分组依据，将3组再分为失衡亚组、平衡亚组，分别统计3组失衡亚组人数所占比例。分析胸腰椎OVCFs组的失衡亚组与平衡亚组矢状位参数、ODI评分、骨折椎体分布差异和两亚组内参数间的相关性。结果：（1）3组间TK、PI差异无统计学意义（P＞0.05）；胸腰椎OVCFs组TLK、SVA、TPA、PT、ODI均大于单纯OP组，单纯OP组均大于骨量正常组（P＜0.05）；胸腰椎OVCFs组LL、SS均小于单纯OP组，单纯OP组均小于骨量正常组（P＜0.05）。骨量正常组TPA与SVA、PI、PT、SS相关，LL与TK、PI、SS 相关，PI与PT、SS相关（P＜0.05）；单纯OP组TPA与SVA、LL、PI、PT、SS相关，TK与SVA、TPA、TLK相关，LL与TK、TLK、PI、SS相关，PI与PT、SS相关（P＜0.05）；胸腰椎OVCFs组TPA与SVA、LL、PI、PT、SS相关，TK与SVA、TLK相关，PT与PI、SS相关（P＜0.05）。（2）单纯OP组、胸腰椎OVCFs组失衡亚组人数所占比例分别为29.41％、44.83％，骨量正常组未发现脊柱矢状位失平衡者。（3）胸腰椎OVCFs组的平衡亚组、失衡亚组多节段椎体骨折人数所占比例分别为37.5％、67.31％，骨折椎体分布无统计学差异（P＞0.05）；平衡亚组TK、TLK、SVA、TPA、PT、ODI均小于失衡亚组，LL、SS均大于失衡亚组（P＜0.05），两组间PI差异无统计学意义（P＞0.05）；平衡亚组SVA与TPA、TK、TLK、LL、PI、PT相关，TPA与 TK、TLK、LL、PI、PT、SS相关，TK与TLK、LL、PT、SS相关，TLK与LL、PI、PT相关，LL与PT、SS相关，PT与PI、SS相关（P＜0.05）；失衡亚组TPA与SVA、LL、PI、PT、SS相关，PT与PI、SS相关（P＜0.05）。结论：胸腰椎OVCFs 患者胸椎后凸、腰椎前凸及骨盆参数间相关性丧失，易发生矢状位失平衡，应积极手术治疗，根据矢状位平衡状况采用不同的手术方法。

英文摘要:

  【Abstract】 Objectives: To investigate the radiographic features of sagittal spino-pelvic parameters in thoracolumbar osteoporotic vertebral compression fractures(OVCFs), and to provide references for clinical treatment of the OVCFs. Methods: This was an analysis of 116 patients(the OVCFs group) with thoracolumbar OVCFs, 102 cases without osteoporotic vertebral fracture were selected as the simple osteoporosis(OP) group, 46 cases of healthy participants with normal bone mineral density(BMD) were selected as the normal BMD group. The distribution of fracture vertebrae was analyzed in the OVCFs group. Sagittal parameters of thoracic kyphosis(TK), thoraco-lumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), T1 pelvic angle(TPA),pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), the Oswestry disability index(ODI) were measured and compared among the three groups, the correlations of the parameters in each group were also analyzed. Each group was divided into balance subgroup and imbalance subgroup according to the spinal sagittal balance. The numbers of cases in three imbalance subgroups were compared. The sagittal parameters of two subgroups were analyzed. Results: (1)No difference in TK, PI was found among the three groups(P＞0.05); TLK, SVA, TPA, PT, ODI in the OVCFs group were higher than those in the simple OP group, and the parameters in the simple OP group were higher than those in the normal BMD group(P＜0.05); LL, SS in the OVCFs group were lower than those in the simple OP group, and LL, SS in the simple OP group was lower than those in the normal BMD group(P＜0.05). Correlation analysis showed that in the normal BMD group, TPA was correlated with SVA, PI, PT, SS; LL was correlated with TK, PI, SS; PI was correlated with PT, SS(P＜0.05). In the simple OP group, TPA was correlated with SVA, LL, PI, PT, SS; TK was correlated with SVA, TPA, TLK; LL was correlated with TK, TLK, PI, SS; PI was correlated with PT, SS(P＜0.05). In the OVCFs group, TPA was correlated with SVA, LL, PI, PT, SS; TK was correlated with SVA, TLK; PT was correlated with PI, SS(P＜0.05). (2)The imbalance subgroup was found in 29.41％ of the simple OP group and 44.83％ of the OVCFs group. (3)Differences in the imbalance subgroup and the balance subgroup of the OVCFs group showed that: the multiple-level vertebral fractures were found in 37.5％ of the balance subgroup and 67.31％of the imbalance subgroup, no difference in the distribution of fracture vertebrae and PI existed between the two subgroups(P＞0.05); TLK, SVA, TPA, PT, ODI in the imbalance subgroup were higher than those in the balance subgroup, however, LL, SS were lower(P＜0.05). In the balance subgroup, SVA was correlated with TPA, TK,TLK, LL, PI, PT; TPA was correlated with TK, TLK, LL, PI, PT, SS; TK was correlated with TLK, LL, PT, SS; TLK was correlated with LL, PI, PT; LL was correlated with PT, SS; PT was correlated with PI, SS(P＜0.05). In the imbalance subgroup, TPA was correlated with SVA, LL, PI, PT, SS; PT was correlated with PI, SS(P＜0.05). Conclusions: When the correlations of parameters of thoracic kyphosis, lumbar lordosis and pelvic are lost in the thoracolumbar OVCFs, sagittal spinal imbalance is more likely to occur in the thoracolumbar OVCFs, the different surgeries should be adopted according to the sagittal spinal balance.