中国汉族正常成人心骶角的测定及意义

The measurement and significance of heart-sacral angles in normal Han nationality adults in China

中文关键词:  心骶角  脊柱  矢状面平衡  冠状面平衡  放射摄影术

英文关键词:Heart-sacral angle  Spine  Sagittal balance  Coronal balance  Radiography

中文摘要:

  【摘要】 目的：测量脊柱与内脏的测量参数心骶角在脊柱全长正侧位X线片上的数据，比较心骶角在不同性别和不同年龄组间差异，并探索其临床应用价值。方法：纳入正常成人108例，男53例，女55例，年龄18~60岁，按照性别和年龄（18~44为青年，45~60为中年）分成四组：第一组为青年男性组（21例）；第二组为中年男性组（32例）；第三组为青年女性组（26例）；第四组为中年女性组（29例）。将脊柱全长正位X线片上S1上终板中点和心脏冠状位最外侧点连线与重垂线之间的夹角定义为冠状位心骶角；将脊柱全长侧位X线片上S1上终板中点和心脏矢状位最前点连线与重垂线之间的夹角定义为矢状位心骶角。采用单因素方差分析比较各组间角度差异。采用独立样本t检验比较男女性别间角度差异，采用组内相关系数评估观测者间信度、观测者内信度以及测量的可重复性。结果：冠状位心骶角测值：青年男性组19.6°±2.8°，中年男性组20.6°±3.5°，青年女性组19.5°±3.6°，中年女性组20.8°±2.3°。矢状位心骶角测值：青年男性组17.0°±4.4°，中年男性组16.7°±4.3°，青年女性组14.7°±3.5°，中年女性组16.3°±4.8°。冠状位和矢状位心骶角在各组间的差异无显著性（P>0.05）。冠状位和矢状位心骶角在男女性别间无显著性差异（P>0.05）。评估观测者间客观信度、观测者内精确信度和测量的可重复性的组内相关系数在0.89~0.98之间（P<0.05）。结论：中国汉族正常成人心骶角是一个解剖常数，具有良好的信度和可重复性，可以作为脊柱-内脏指标参与评估脊柱在冠状位和矢状位的平衡。

英文摘要:

  【Abstract】 Objectives: To measure a new spine-internal organ parameter: heart-sacral angle, in full length, free-standing spine radiograph, and to compare the differences between genders and ages and the clinical values. Methods: A prospective cohort of 108 normal Han nationality adults in China were divided into 4 groups: Group 1(18-44y, males); Group 2(45-60y, males); Group 3(18-44y, females); Group 4(45-60y, females). Coronal heart-sacral angle was defined as the angle between a vertical line through the midpoint of S1 endplate and a line connecting the midpoint of S1 endplate to the outermost point of heart in full length, free-standing posteroanteriorspine radiographs. Sagittal heart-sacral angle defined as the angle between a vertical line through the midpoint of S1 endplate and a line connecting the midpoint of S1 endplate to the forefront point of heart in full length, free-standing lateralspine radiographs. One-way Anova test was used to compare the angle differences among 4 groups. Two-sample t-test was used to compare the angle differences between genders. Introclass correlation coefficient(ICC) was used to reflect the consistency of measurements by the same observer, among the three observers and repeatability of the three measurements by three observers. Results: Coronal heart-sacral angle was Group 1, 19.6°±2.8°; Group 2, 20.6°±3.5°; Group 3, 19.5°±3.6°; Group 4, 20.8°±2.3°. Sagittal heart-sacral angle was Group 1, 17.0°±4.4°; Group 2, 16.7°±4.3°; Group 3, 14.7°±3.5°; Group 4, 16.3°±4.8°. There were no significant differences in coronal and sagittal heart-sacral angles among 4 groups and between genders(P>0.05). ICC of the consistency of measurements by the same observer, among the three observers and repeatability of the three measurements by three observers wasbetween 0.89-0.98(P<0.05). Conclusions: Heart-sacral angles in normal Han nationality adults in China are anatomical constants with good reliability and reproducibility, it can be used as spine-internal organ parameters to evaluate the coronal and sagittal balances of spine.