退变性腰椎侧凸合并类风湿性关节炎患者侧凸程度的影响因素分析

The influencing factor of degenerative lumbar scoliosis severity in patients with rheumatoid arthritis: a case-control study

中文关键词:  类风湿性关节炎  退变性腰椎侧凸  全膝关节置换术  膝关节功能评分  影响因素

英文关键词:Rheumatoid arthritis  Degenerative lumbar scoliosis  Total knee arthroplasty  Knee society score  Influencing factor

中文摘要:

  【摘要】 目的：分析退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）合并类风湿性关节炎（rheumatoid arthritis，RA）患者的发病特征和侧凸程度的影响因素。方法：单中心纳入2013年1月～2018年4月61例合并RA拟行腰椎手术的患者，分为患有DLS者27例（DLS组）和无脊柱畸形患者34例（NDLS组）。提取信息包括人口统计学信息[如性别、年龄和体重指数（body mass index，BMI）等]、RA相关信息[如Steinbrocker分级、是否服用改变病情抗风湿药（disease-modifying anti-rheumatic drugs，DMARDs）等]、手术相关信息和DLS信息[如Cobb角、顶椎旋转角度、冠状位顶椎偏移距离、髂嵴连线高度、骨质疏松、全膝关节置换（total knee arthroplasty，TKA）史和膝关节功能评分（knee society score，KSS）]，Steinbrocker分级用来评价RA活动性，Cobb角反映腰椎侧凸程度，KSS用以评价膝关节功能。结果：患者平均RA病程为16.8±12.7年，Steinbrocker分级Ⅰ～Ⅲ级分别为14例、34例和13例。两组患者以女性为主，DLS组（男∶女=1∶26）和NDLS组（男∶女=8∶26）在性别上存在统计学差异（P=0.031），而在年龄、BMI上无统计学差异（P＞0.05）；两组在Steinbrocker分级、服用DMARDs比例和骨质疏松患者比例上无统计学差异（P＞0.05）。两组共11例实施TKA手术，两组间TKA分布比较无统计学差异（P=0.153）。DLS组平均侧凸程度（Cobb角）为18.4°±9.0°（10.4°～39.2°），实施TKA患者其Cobb角（11.8°±1.5°）小于无TKA者（20.6°±9.5°）（P=0.001）。DLS组顶椎旋转角度为8.4°±6.8°，冠状位偏移距离为47.3±7.8mm，髂嵴连线均位于L4/5椎间隙。Cobb角与顶椎旋转角度、冠状位偏移距离和TKA存在相关性（P＜0.05），与其余参数均无显著相关性。针对DLS患者侧凸程度回归分析，显示既往行TKA为其影响因素（P=0.029），但TKA发生时间、TKA患者DLS病程与侧凸程度无明确相关性。行TKA患者KSS评分（88.7±5.3分）高于未行TKA者（80.4±10.0分）（P=0.034），KSS和Cobb角之间存在负相关性（r=-0.717，P＜0.001），以Cobb为因变量的两者之间的拟合曲线为Cobb角=70.38-0.64×KSS。结论：合并RA的DLS患者在中老年女性更易出现；在既往行TKA的RA患者中，DLS侧凸程度较小；KSS与DLS侧凸程度存在高度相关性。

英文摘要:

  【Abstract】 Objectives: To perform retrospective analysis on patients with rheumatoid arthritis(RA) diagnosed as degenerative lumbar scoliosis(DLS), and to clarify the influencing factors of the degree of scoliosis. Methods: The single-center study enrolled 61 RA underwent lumbar spine surgery from January 2013 to April 2018 according to the inclusion criteria. They were divided into DLS group(27 cases) and NDLS group with non-spine deformity(34 cases). The extracted information includes demographic information such as gender, age, and body mass index(BMI), RA-related parameters such as disease duration, Steinbrocker classification, disease-modifying anti-rheumatic drugs(DMARDs), surgery-related information and information on DLS such as the incidence of DLS, Cobb angle, intercrestal line, rotation angle and coronal displacement of apical vertebrae, osteoporosis, total knee arthroplasty(TKA) history and knee society score(KSS). Steinbrocker classification was used to evaluate the activity of RA, Cobb angle was to reflect the degree of lumbar scoliosis, and KSS was induced to evaluate knee function. Results: The mean RA duration was 16.8±12.7 years. There were respectively 14 cases, 34 cases and 13 cases in grade Ⅰ, Ⅱ and Ⅲ of Steinbrocker classification. Females were the majorities of the two groups. There was a statistical difference in gender between DLS group(male∶female=1∶26) and NDLS group(male∶female=8∶26)(P=0.031), but none in age and BMI(both P>0.05). There was no statistical difference in Steinbrocker classification, proportion of taking DMARDs and osteoporosis(P>0.05). A total of 11 patients underwent TKA and there was no significance in TKA distribution between the two groups(P=0.153). The mean Cobb angle in DLS group was 18.4°±9.0°(10.4°-39.2°). The Cobb angle(11.8°±1.5°) in patients underwent TKA was less than those without TKA(20.6°±9.5°) (P=0.001). Rotation angle and coronal displacement of apical vertebrae were respectively 8.4°±6.8° and 47.3±7.8mm, and almost all the intercrestal line was within L4/5 level. Cobb angle was in correlation to rotation angle and coronal displacement of apical vertebrae and TKA(P<0.05), but not to other parameters. Linear regression analysis for scoliosis degree in DLS group showed that TKA was the independent influencing factor(P=0.029), while there was unclear correlation with TKA duration and Cobb angle. KSS(88.7±5.3) in patients with TKA was higher than ones without TKA(80.4±10.0)(P=0.034). There was a negative correlation between KSS and Cobb angle(r=-0.717, P<0.001). The fitting formula between the two variables was Cobb angle=70.38-0.64×KSS. Conclusions: DLS are more susceptible in middle-aged and elderly women in RA patients. Patients previously underwent TKA suffer from less severe degree of DLS and there is a close correlation between KSS and Cobb angle.