先天性腰骶部畸形对骨盆平衡的影响

The influence of congenital lumbosacral deformity on pelvic balance

中文关键词:  腰骶部畸形  半椎体  骨盆平衡  骨盆倾斜  骨盆旋转

英文关键词:Lumbosacral deformity  Hemivertebra  Pelvic balance  Pelvic obliquity  Pelvic rotation

中文摘要:

  【摘要】 目的：通过回顾性分析先天性腰骶部畸形患者的影像学资料，探讨先天性腰骶部畸形对于骨盆平衡的影响。方法：回顾性分析2007年1月~2018年9月本团队诊治的腰骶部畸形患者，排除仅有矢状面畸形、既往有脊柱手术史、双下肢不等长≥2cm或合并髋关节疾病者。最终纳入26例患者，其中男8例，女18例，年龄13.8±6.9岁（6~33岁）。将患者分为A组（单纯腰骶部畸形，9例）、B组（腰骶部畸形合并其他部位椎体畸形，12例）与C组（腰椎与骶椎复杂畸形，5例）。测量并比较A、B组的腰骶部节段Cobb角，3组的冠状面骨盆倾斜角（PO）、矢状面骶骨倾斜角（SIA）与横断面骨盆旋转（PR）。PO>2°、SIA<30°或>45°及PR>1.2分别为冠状面、矢状面及横断面骨盆失衡的标准。结果：3组病例的年龄、性别无统计学差异（P=0.469，P=0.813）。A、B组节段Cobb角分别为24.0°±13.6°与28.3°±14.4°，无显著性差异（P=0.497）。A、B、C组的PO分别为1.7°±2.3°、4.9°±6.7°、18.9°±12.7°，C组PO显著大于A、B组（A组与C组P=0.002，B组与C组P=0.009），A、B组间无统计学差异（P=0.200）。3组的SIA分别为38.7°±6.8°、36.1°±18.2°、28.4°±9.3°，3组间均无统计学差异（P=0.418）。3组的PR分别为1.09±0.05、1.22±0.15、1.44±0.51，B组PR显著大于A组（P=0.002），余无统计学差异（A组与C组比较P=0.061，B组与C组比较P=0.191）。A组、B组、C组在冠状面上骨盆失衡的发生率分别为33.3%、77.8%、100%，在矢状面上分别为11.1%、58.3%、40.0%，在横断面上分别为0、41.7%、60.0%。单纯腰骶部半椎体病例未见明显骨盆失衡。所有PR>1.15及93.3%的PR>1.10的病例中骨盆旋转方向与主弯方向一致。结论：单纯腰骶部半椎体不会引起明显骨盆失衡。腰骶部畸形合并其他部位椎体畸形，尤其是腰椎与骶椎复杂畸形时，更容易造成骨盆失衡。腰骶部畸形引起的骨盆旋转方向与主弯方向一致。

英文摘要:

  【Abstract】 Objectives: To analyze the influence of lumbosacral deformity on pelvic balance by retrospectively reviewing the medical images of lumbosacral deformity patients. Methods: All lumbosacral deformity patients treated in our hospital between January 2007 and September 2018 were retrospectively reviewed. Those with only sagittal deformity, previous spinal surgery, discrepancy of leg length ≥2cm or hip disease were excluded. 26 patients were recruited with a mean age of 13.8±6.9, including 8 male patients and 18 female patients. These patients were divided into group A(only lumbosacral deformity, n=9), group B(lumbosacral deformity combined with vertebral deformity in other regions, n=12) and group C(complex deformity in lumbar and sacral region, n=5). Segmental Cobb angles were measured and compared in group A and B. Pelvic obliquity(PO) in coronal plane, sacral inclination angle(SIA) in sagittal plane and pelvic rotation(PR) in transverse plane were measured. The three-dimensional pelvic balance was analyzed and compared among three groups. PO>2°, SIA<30° or >45° and PR>1.2 were set as the criteria for pelvic imbalance in coronal, sagittal and transverse planes respectively. Results: The three groups had no statistically significant difference in age or gender. The mean segmental Cobb angles in group A and B were 24.0°±13.6° and 28.3°±14.4° respectively, with no statistically significant difference(P=0.497). Mean PO in three groups was 1.7°±2.3°, 4.9°±6.7° and 18.9°±12.7°, with PO in group C significantly greater than that in group A and B (group C vs group A: P=0.002, group C vs group B: P=0.009) and no statistically significant difference between group A and B(P=0.200). Mean SIA in three groups was 38.7°±6.8°, 36.1°±18.2° and 28.4°±9.3°, with no statistically significant difference between three groups(P=0.418). Mean PR in three groups were 1.09±0.05, 1.22±0.15 and 1.44±0.51, with PR in group B significantly greater than that in group A(P=0.002) and no statistically significant difference between group A and C(P=0.061) or between group B and C(P=0.191). The incidence of pelvic imbalance in three groups (group A, group B, group C) in coronal, sagittal and transverse planes was 33.3%, 77.8%, 100%; 11.1%, 58.3%, 40.0% and 0%, 41.7%, 60.0% respectively. No significant pelvic imbalance was identified in cases with only lumbosacral hemivertebrae. All patients with PR>1.15 and 93.3% patients with PR>1.10 had their pelvis rotated in consistence with the direction of main curves. Conclusions: The pelvis can maintain balance in patients with only lumbosacral hemivertebrae. The lumbosacral deformities combined with other vertebral deformities, especially complex lumbar and sacral deformities, are more likely to cause three-dimensional pelvic imbalance. The direction of pelvic rotation caused by lumbosacral deformity is consistent with the direction of main curve