国人青年人群坐-立位脊柱-骨盆矢状位序列变化研究

Analysis of spino-pelvic sagittal alignment in Chinese young subjects in standing versus sitting positions

中文关键词:  脊柱  骨盆  坐立位  矢状位序列

英文关键词:Spine  Pelvis  Sitting-standing position  Sagittal alignment

中文摘要:

  【摘要】 目的：通过对正常国人青年人群进行坐-立位脊柱-骨盆矢状位序列的影像学研究，观察坐位脊柱-骨盆矢状位序列变化特点，探讨坐位下躯干矢状位平衡的调节机制。方法：在医院周边高校招募青年志愿者，共145名志愿者纳入研究，其中男51人，女94人，平均年龄23.1±2.3岁（19～29岁）。所有志愿者行站立位-坐位全脊柱正侧位X线片。应用院内PACS系统，测量如下参数：骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）、胸椎后凸角（TK）、胸腰段后凸角（TLK）、腰椎倾斜角（LT）、脊柱矢状位平衡（SVA）、T1骨盆角（T1PA）。采用配对样本t检验，对比站立位、坐位脊柱-骨盆矢状位参数变化；运用Pearson相关分析，分别分析站立位、坐位脊柱-骨盆矢状位参数间相关性。检验水准α=0.05。结果：PI平均值为46.6°±9.1°。当体位由站立位改为坐位后，除胸腰段曲度外，脊柱-骨盆矢状位位置参数均发生显著改变。PT增大（11.8°±6.5° vs 28.4°±10.0°），SS减小（34.9°±7.1° vs 19.7°±8.7°），骨盆围绕双侧股骨头中心向后旋转。LL（50.4°±10.0° vs 25.3°±11.8°）、TK（26.1°±10.2° vs 20.0°±8.9°）显著减小，LT（-5.0°±5.0° vs -1.8°±5.8°）显著增大，腰弯、胸弯代偿减小，曲度变得平直，同时腰椎相对骶骨向前倾斜。SVA（-20.1±22.4mm vs 26.9±28.6mm）、T1PA（5.6°±6.0° vs 23.7°±9.3°）均明显增大，躯体矢状位平衡轴向前移动。由站立位改变为坐位后，PI、LL与矢状位平衡参数SVA、T1PA相关性进一步增强。结论：坐位时腰骶部矢状位序列会发生显著改变，表现为骨盆后倾旋转，腰椎与胸椎曲度变得平直，腰椎向前倾斜，躯干矢状位轴向前移动。这种调节与代偿的变化，需要在胸腰椎固定融合手术特别是长节段固定融合和矫形手术中充分考量。

英文摘要:

  【Abstract】 Objectives: To analyze the spino-pelvic sagittal alignment of Chinese asymptomatic adults in standing versus sitting positions, based on the characteristics of asymptomatic adults′ sagittal alignment in standing, the variation in sitting position. Methods: This was a prospective radiological analysis by using full-spine standing and sitting lateral radiographs of Chinese volunteers. 145 volunteers(51 males, 94 females; mean age, 23.1±2.3 years) participated. Pelvic and spinal parameters were measured, including pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), thoracic kyphosis(TK), thoracic lordotic kyphosis(TLK), lordosis tilt(LT), sagittal vertical axis(SVA) and T1-pelvic angle(T1PA). By using Student′s t test, the angular parameters were compared between standing posture and sitting posture. By using Pearson′s correlation test according to different position, difference of relationship between spinal and pelvic parameters in standing versus sitting position were discussed. Results: Mean PI was 46.6°±9.1°. When moving from standing to sitting position, the spine lost nearly 24° of LL(49.6°±9.8° vs 25.2°±10.8°, P<0.001). The SVA also moved more anteriorly by 45mm(-20.7±20.8mm vs 24.5±29.5mm, P<0.001). Regarding changes from the standing to sitting position, average PT, LT, T1PA were greater(P<0.05), and TK, SS were decreased(P<0.05). In sitting position, the correlations of PI-SVA, LL-SVA, PI-T1PA, LL-T1PA were enhanced. Conclusions: In sitting position, the majority of changes occures in the lumbar spine and pelvis alignment. Sitting significantly straightens the spine with decreased TK, LL and SS. Lumbar alignment and SVA move anteriorly. Pelvis rotation and lumbar hypolordosis are the mechanisms of adjusting the trunk sagittal balance in sitting position. This variation in sitting position should be fully considered in terms of long-term effects of the sitting position in patients with lumbar and thoracic fusion.