非特异性腰痛患者坐-立位脊柱序列变化的研究

Study on spinal sagittal alignment at standing and sitting position in patients with non-specific low back pain

中文关键词:  非特异性腰痛  坐-立位  脊柱矢状位序列

英文关键词:Non-specific low back pain  Sitting-standing position  Spinal sagittal alignment

中文摘要:

  【摘要】 目的：研究非特异性腰痛（nonspecific low back pain，NLBP）患者坐-立位脊柱序列变化的特点。方法：选择NLBP患者50例，其中男15例，女35例，年龄为48.0±10.7岁；同时招募50名健康志愿者作为对照组，其中男17例，女33例，年龄为45.2±10.6岁。采用脊柱形态测量仪（Spinalmouse?誖）分别测量两组坐位及立位胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骶骨倾角（sacral inclination，SacHipJ）、倾角（inclination，Incl）。采用Wilcoxon检验，分别对比各组坐位和立位的脊柱参数；采用Mann-Whitney U检验，对比两组立位脊柱参数、坐位脊柱参数及坐-立位脊柱参数变化量（difference value，D）；采用Spearman检验，评估NLBP组腰痛的视觉模拟量表（visual analogue scale，VAS）评分与坐位LL、立位LL及D-LL的相关性；以30~39岁、40~49岁、50~59岁、60~69岁分为四个年龄段，采用Kruskal-Wallis H检验，对比NLBP组各年龄段坐位LL、立位LL及D-LL的差异。结果：立位变为坐位时，两组的TK、LL、SacHipJ均变小（P<0.05），Incl均增大（P<0.05）；立位时，两组参数无统计学差异（P>0.05）；坐位时，NLBP组LL较对照组大，Incl较对照组小（P<0.05）；NLBP组D-TK、D-LL、D-Incl均较对照组小（P<0.05）。NLBP组的VAS评分与立位及坐位LL相关性无统计学意义（P>0.05），与D-LL呈弱的负相关（rs=-0.293，P<0.05）。NLBP组坐位LL、立位LL及D-LL不同年龄段间的差异无统计学意义（P>0.05）。结论：NLBP患者坐-立位脊柱序列不同于健康人群，表现为坐位时LL较健康受试者大，而从立位转变为坐位时，除骨盆后旋外，胸椎与腰椎曲度变小及躯干前移的变化量均较健康受试者小。

英文摘要:

  【Abstract】 Objectives: To study the spinal sagittal alignment at standing and sitting positions in patients with non-specific low back pain (NLBP). Methods: 50 NLBP patients (15 males and 35 females; mean age 48.0±10.7 years) were included and 50 healthy volunteers (17 males, 33 females; mean age 45.2±10.6 years) were recruited as control group. Spinalmouse was used to measure the angles of thoracic kyphosis (TK), lumbar lordosis (LL), sacral inclination (SacHipJ) and inclination (Incl) of the two groups at sitting and standing positions respectively. Wilcoxon test was used to compare the differences of spinal parameters between sitting and standing positions in each group, and Mann-Whitney U test was used to compare the differences of the spinal parameters of the standing position, sitting position and the difference value(D) from standing to sitting positions between the two groups. Spearman test was used to analyze the correlation among visual analogue scale(VAS) of the low back pain and LL at sitting and standing position and D-LL in the NLBP group. NLBP group was divided into four age groups: 30-39 years old, 40-49 years old, 50-59 years old, and 60-69 years old, and Kruskal-Wallis H test was used to compare the differences of LL at sitting and standing position and D-LL at different ages in the NLBP group. Results: When the position was changed from standing to sitting, TK, LL and SacHipJ decreased(P<0.05) and Incl increased(P<0.05) in both groups. In standing position, there was no difference in angles between the two groups(P<0.05). In the sitting position, the LL was greater and the Incl was smaller(P<0.05) in NLBP group than those in the control group. When the position was changed from standing to sitting, the angle variation of TK, LL and Incl in NLBP group were smaller than those in control group(P<0.05). VAS had no correlation with LL at standing or sitting position(P>0.05), but there was a weak negative correlation with the D-LL(rs=-0.293, P<0.05) in the NLBP group. There was no statistically significant difference among LL at sitting and standing position or D-LL at different ages in the NLBP group(P>0.05). Conclusions: Spinal sagittal alignment at standing and sitting position in patients with NLBP was different from that of healthy people: the LL was greater than that of healthy subjects in the sitting position, and the variation of thoracic spine and lumbar spine flattening and trunk forward movement were smaller than those of healthy subjects in the shift from the standing position to the sitting position, except for the posterior rotation of pelvis.