高位腰椎间盘突出症患者脊柱-骨盆矢状面形态的影像学分析

Radiological analysis of sagittal spino-pelvic alignment in patients with upper lumbar disc herniation

中文关键词:  高位腰椎间盘突出症  骨盆入射角  腰椎前凸角  Roussouly分型

英文关键词:Upper lumbar disc herniation  Pelvic incidence  Lumbar lordosis  Roussouly classification

中文摘要:

  【摘要】 目的：评估高位腰椎间盘突出症（upper lumbar disc herniation，ULDH）患者的脊柱-骨盆矢状面形态影像学表现，探讨脊柱-骨盆矢状面形态在ULDH发病机制中的意义。方法：选取2007年1月~2016年12月行手术治疗的29例ULDH患者，其中L1/2椎间盘突出9例，L2/3椎间盘突出16例, L1/2和L2/3双节段椎间盘突出4例；正常无椎间盘突出志愿者58例为对照组。ULDH组年龄20~56岁，女10例，男19例；对照组年龄22~56岁，女21例，男37例。两组的年龄、性别、体重指数比较均无统计学差异（P>0.05）。在站立位全脊柱正侧位X线片上测量两组的脊柱-骨盆矢状面形态学参数，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）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、胸腰段后凸角（thoracolumbar junctional angle，TLJ）、矢状面平衡（sagittal vertical axis，SVA）；ULDH组测量突出节段椎间盘前、后缘高度和椎间盘角度，对照组测量L1/2、L2/3椎间盘；观察两组是否存在滑脱及椎体楔形变，测量滑脱距离及楔形变角度。根据矢状面形态进行Roussouly分型并比较两组间脊柱-骨盆矢状面参数和Roussouly分型结果。结果：ULDH组的PI、PT、SS和LL分别为36.0°±8.8°、12.5°±6.7°、23.4°±9.6°、36.1°±9.1°，明显低于对照组的43.6°±8.6°、15.4°±6.7°、28.0°±9.1°、48.1°±9.0°（P均<0.05）；ULDH组的TK、TLJ和SVA分别为33.3°±11.0°、17.0°±6.6°、5.6±20.1mm，明显高于对照组的26.7°±12.1°、6.2°±5.8°、-18.2±16.6mm（P均<0.05）。ULDH组的L1/2椎间盘前、后缘高度分别为6.1±1.9mm和5.1±2.1mm，明显低于对照组的9.7±1.8mm和8.5±2.4mm（P<0.05）；L2/3椎间盘前、后缘高度分别为7.1±2.1mm和5.1±2.7mm，明显低于对照组的9.5±1.9mm和8.3±2.6mm（P<0.05）。ULDH组L1/2和L2/3椎间盘角度分别为4.9°±3.0°和5.2°±2.9°，明显高于对照组的3.2°±2.7°和3.1°±2.6°（P<0.05）。ULDH组中后滑脱患者10例（34.5%），明显高于对照组（0%）（P<0.05）。ULDH组后滑脱距离5.3±1.9mm，24例（82.8%）椎间盘突出节段邻近椎体存在明显楔形变（8.7°±2.4°）；而对照组仅2例（3.4%）存在腰段椎体楔形变，比例明显低于ULDH组（P<0.05）。ULDH组Roussouly分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型所占比例分别为48.3%、31.0%、17.3%和3.4%，对照组分别为10.3%、46.6%、32.8%和10.3%，其中Ⅰ型在ULDH组所占比例明显高于对照组（P<0.05），其余分型在两组间无显著性差异（P＞0.05）。结论：ULDH患者以Roussouly分型Ⅰ型居多，PI较低，且较正常人群相应节段椎间盘高度显著降低、椎间隙角度增加。

英文摘要:

  【Abstract】 Objectives: To analyze the sagittal spino-pelvic alignment and its clinical relevance with upper lumbar disc herniation(ULDH). Methods: A total of 29 ULDH patients and 58 normal volunteers from January 2007 to January 2017 were included in this study. Disc herniation was identified in 9 patients at L1/2 level, in 16 patients at L2/3 level， and in 4 patients at both l/2 and L2/3 level. ULDH group contained 29 patients(10 females, 19 males), aged 20-56 years. Control group consisted of 58 volunteers (21 females, 37 males), aged 22-56 years. No differences were found between two groups in terms of age, gender and BMI. Spino-pelvic parameters including pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), thoracic kyphosis(TK), lumbar lordosis(LL), thoracolumbar junctional angle(TLJ) and sagittal vertical axis(SVA) were obtained. From the standing lateral X-ray films of spine, disc angle, vertebral wedging angle, anterior and posterior disc height, slippage distance were measured. At the same time, distributions of Roussously classification in all patients were determined. Spino-pelvic parameters between two groups were compared via independent t test. Results: The PI, PT, SS and LL in ULDH group were 36.0°±8.8°, 12.5°±6.7°, 23.4°±9.6° and 36.1°±9.1° respectively, which were significantly lower than those in the control group(43.6°±8.6°, 15.4°±6.7°, 28.0°±9.1° and 48.1°±9.0° respectively, P<0.05). However, TK, TLJ and SVA were 33.3°±11.0°, 17.0°±6.6° and 5.6±20.1mm respectively, which were significantly higher than those in the control group(26.7°±12.1°, 6.2°±5.8° and -18.2±16.6mm respectively, P<0.05). In ULDH group, anterior and posterior height of L1/2 disc were 6.1±1.9mm and 5.1±2.1mm respectively, which were significantly lower than those in the control group(9.7±1.8mm and 8.5±2.4mm respectively, P<0.05). Similarly, anterior and posterior height of L2/3 disc were 7.1±2.1mm and 5.1±2.7mm respectively, which were significantly lower than those in the control group(9.5±1.9mm and 8.3±2.6mm respectively, P<0.05). In ULDH group, disc angle at L1/2 and L2/3 was 4.9°±3.0° and 5.2°±2.9° respectively, which was significantly higher than that in the control group(3.2°±2.7° and 3.1°±2.6°, P<0.05). Retrolisthesis was observed in 10 patients(34.5%) in ULDH group, which was significantly higher than that in the control group(0%)(P<0.05). Slippage distance was 5.3±1.9mm in ULDH group. Vertebral wedging was more frequently noted in ULDH group(24/29) than in the control group(2/58)(P<0.05). In ULDH group, the distribution from Roussouly type Ⅰ to Ⅳ was 48.3%, 31.0%, 17.3% and 3.4% respectively; while in control group, it 10.3%, 46.6%, 32.8% and 10.3% respectively. The distribution of type Ⅰ in ULDH group was significantly higher than that in control group(P<0.05), while no significant differences were found in other types between the two groups(P＞0.05). Conclusions: ULDH patients have a distinct spino-pelvic alignment characterized by a low PI and a high distribution of Roussouly type Ⅰ.Besides, the decrease of disc height and increase of disc angle were significant in ULDH patients when compared with the controls.