未成年人骶骨参数与脊柱-骨盆矢状位参数的相关性研究

Correlation between sacral parameters and the sagittal position parameters of spine and pelvis in juveniles

中文关键词:  骶骨  脊柱-骨盆参数  矢状位序列  未成年人

英文关键词:Sacrum  Spino-pelvic parameters  Sagittal alignment  Juvenile

中文摘要:

  【摘要】 目的：探讨未成年人骶骨参数与脊柱-骨盆矢状位参数的相关性。方法：对120例2～17岁正常未成年人自然站立位脊柱全长X线侧位片进行影像学参数测量。其中男性55例，女性65例，平均年龄9.9±3.2岁。测量其腰椎前凸角（lumbar lordosis，LL）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）；测量骶骨形态学参数：骶1-2（S1-2）的倾斜线与S1终板垂线的夹角（S1-2倾斜角，S1-2T）、S1-2倾斜线与S5尾1（S5Co1）倾斜线的夹角（骶骨后凸角，sacral kyphosis，SK）、S1-S3中点倾斜线与S4中点-Co1倾斜线的夹角（新骶骨后凸角，SK′）、S2椎体前缘与S4Co1倾斜线夹角（α）、S1上终板与S2椎体前缘夹角（β）、S4Co1倾斜线与S1上终板夹角（θ）；测量骶骨体位学参数：S2椎体前缘水平角（S2HA）、S5Co1倾斜线水平角（S5Co1HA）。对PI与LL、PI与SK′、LL与SK、S2HA与SS、S5Co1HA与固定值90°行配对t检验并两两求差值，对骶骨形态学参数与PI、LL以及PI与LL进行Pearson相关性分析，制作β、θ与PI散点图并求得β、θ与PI线性回归方程；分析儿童（2～9岁）、青少年（10～17岁）PI、SK、SK′、α、θ与LL相关性。结果：LL=50.3°±12.1°，PI=43.9°±11.0°，PT=5.7°±9.0°，SS=36.4°±7.6°，S1-2T=-15.5°±5.6°，SK=51.4°±10.7°，SK′=44.3°±10.5°，α=47.5°±9.7°，β=68.5°±8.2°，θ=64.0°±13.0°，S2HA=32.1°±9.0°，S5Co1HA=90.3°±11.8°。PI与LL、S2HA与SS均有统计学差异（P<0.01），PI与SK′、LL与SK、S5Co1HA与固定值90°均无统计学差异（P>0.01），差值关系为PI=SK′±12°，LL=（SK-1.4°）±15°，S5Co1HA=90°±12°；S1-2T、SK、SK′、α、β、θ与PI均有相关性（P<0.01），相关性系数（r）分别为0.578、0.440、0.429、0.374、0.641、-0.683；SK、SK′、α、θ与LL有显著相关性（P<0.01），r值分别为0.265、0.282、0.273、-0.314；S1-2T、β与LL无明显相关性（P>0.01），r值分别为0.136、0.173；PI与LL无相关性（r=0.164，P>0.01）；线性回归方程：PI=0.451β-0.39θ+37.973（r=0.728）。儿童PI、SK、SK′、α、θ与LL的r值分别为0.054、0.076、0.074、0.066、0.059，均无明显相关性（P>0.01）；青少年PI与LL无明显相关性（r=0.246，P>0.01），SK、SK′、α、θ与LL有显著相关性（P<0.01），r值分别为0.391、0.417、0.411、0.481。结论：未成年人PI可由SK′、β、θ预测，PI与LL无显著相关性；青少年骶骨形态参数与LL具有良好相关性，利用骶骨形态参数预测青少年LL可能比PI更稳定可靠。

英文摘要:

  【Abstract】 Objectives: To explore the correlation between sacrum morphology and sagittal position parameters of the spine in juveniles. Methods: The full-length free-standing radiographs of 120 normal minors were reviewed, including 55 males and 65 females, with an average age of 5 years. Radiological parameters, including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured. Ferguson method was used to measure the angles between S1-2 tilt and the vertical line of the upper end plate of S1 (S1-2T), between S1-2 tilt and S5Co1 tilt (sacral kyphosis, SK), between S1-3 tilt and S4Co1 tilt (SK′), between the anterior edge of S2 and S4Co1 tilt (α), between the upper endplate of S1 and the anterior edge of S2 (β), and between S4Co1 tilt and the upper endplate of S1(θ). The sacral position parameters including the horizontal angle of anterior edge of S2(S2HA) and the horizontal angle of S5Co1 tilt (S5Co1HA) were measured. PI and LL, PI and SK′, LL and SK, S2HA and SS, S5Co1HA and fixed value 90° were tested by paired-samples t test and the differences were calculated. The Pearson correlations between sacral morphological parameters and PI, LL and PI and LL were analyzed. The scatter plot of β, θ and PI was made and the linear regression equation of β, θ and PI was obtained. The correlations between PI, SK, SK′, α, θ and LL in children (2-9 years) and adolescents (10-17 years) were analyzed by stages. Results: LL=50.3°±12.1°, PI=43.9°±11.0°, PT=5.7°±9.0°, SS=36.4°±7.6°, S1-2T=-15.5°±5.6°, SK=51.4°±10.7°, SK′=44.3°±10.5°, α=47.5°±9.7°, β=68.5°±8.2°, θ=64.0°±13.0°, S2HA=32.1°±9.0°, and S5Co1HA=90.3°±11.8°. There were significant differences between PI and LL, S2HA and SS, but there were no significant differences between PI and SK′, LL and SK, S5Co1HA and 90° of fixed value. The difference was PI=SK′±12°, LL=(SK-1.4°)±15°, S5Co1HA=90°±12°; S1-2T, SK, SK′, α, β, θ were correlated with PI (P<0.01), and the correlation coefficients (r) were 0.578, 0.440, 0.429, 0.374, 0.641, -0.683, respectively. The r values of SK, SK′, α, θ and LL were 0.265, 0.282, 0.273, -0.314, respectively, with significant correlation(P<0.01). The r values of S1-2T, β and LL were 0.136, 0.173, respectively, without significant correlation (P>0.01). There was no correlation between PI and LL (r=0.164, P>0.01). Regression equation: PI=0.451β-0.39θ+37.973 (r=0.728). The r values of LL and PI, SK, SK′, α, θ were 0.054, 0.076, 0.074, 0.066, 0.059, respectively, with no significant correlation. There was significant correlation between PI and LL (r=0.246, P>0.01). There were significant correlation between LL and SK, SK′, α, θ(r=0.391, 0.417, 0.411, 0.481, P<0.01). Conclusions: Juvenile PI can be predicted by SK′, β, and θ. Juvenile PI-LL has no correlation. There was a good correlation between the morphological parameters of sacrum and LL in adolescents. The use of sacral morphological parameters may be more stable and reliable than PI prediction to evaluate LL in adolescent.