胸廓入射角对强直性脊柱炎胸腰椎后凸畸形患者腰椎截骨矫形术后颈椎矢状面序列的影响

The influence of thoracic inlet angle on the cervical sagittal alignment in ankylosing spondylitis patients with thoracolumbar kyphosis following lumbar pedicle subtraction osteotomy

中文关键词:  强直性脊柱炎  胸腰椎后凸  椎弓根椎体截骨矫形手术  胸廓矢状面序列  颈椎矢状面序列

英文关键词:Ankylosing spondylitis  Thoracolumbar kyphosis  Pedicle subtraction osteotomy  Thoracic sagittal alignment  Cervical sagittal alignment

中文摘要:

  【摘要】 目的：探讨不同胸廓入射角 （thoracic inlet angle，TIA）下的强直性脊柱炎 （ankylosing spondylitis，AS）伴胸腰椎后凸畸形患者腰椎截骨矫形术后颈椎矢状面排序的影像学特征。方法：回顾性分析2012年1月~2020年12月于我院脊柱外科就诊并接受脊柱后路经椎弓根椎体截骨矫形手术（pedicle subtraction osteotomy，PSO）治疗的AS伴胸腰椎后凸畸形患者32例。收集患者性别、年龄、截骨节段、椎体融合节段等临床资料。在术前、术后即刻、末次随访时的全脊柱侧位X线片上测量：颈椎矢状面偏移（cervical sagittal vertical axis，cSVA）、麦氏线倾斜角（McGregor slope，McGs）、上颈椎前凸角（upper cervical lordosis，UCL）、下颈椎前凸角（lower cervical lordosis，LCL）、全颈椎前凸角（cervical lordosis，CL）、C2椎体倾斜度（C2 slope）、C7椎体倾斜度（C7 slope）、T1椎体倾斜度（T1 slope，T1S）、颈部倾斜度（neck tilt，NT）、胸廓入射角（thoracic inlet angle，TIA）、全脊柱整体后凸角（global kyphosis，GK）、胸椎后凸角（thoracic kyphosis，TK）、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）、局部后凸角（local kyphosis，LK）。根据TIA值分为A、B两组：A组TIA<70°，B组TIA≥70°。采用独立样本t检验或卡方检验比较两组患者术前临床资料和术前术后影像学参数的差异，将术前有显著性差异的参数与TIA进行Pearson相关性分析。结果：A组患者共15例，男13例，女2例，年龄28.5±5.7岁；B组患者共17例，男13例，女4例，年龄37.7±14.4岁。A组患者术前的cSVA、UCL、CL、TK、GK分别为33.6±17.2mm、-14.6°±4.9°、-43.7°±12.9°、32.6°±10.8°、52.3°±10.3°，B组的分别为48.0±18.1mm、-22.8°±7.4°、-56.3°±10.9°、50.1°±9.9°、69.8°±11.9°，两组间比较均有统计学差异（P<0.05）；术前两组间McGs与LCL无统计学差异（P>0.05）。术后即刻A组患者的LCL、CL、TK分别为-11.1°±8.9°，-24.4°±10.2°，33.5°±11.3°，B组分别为-20.9°±11.9°、-35.0°±9.4°、46.2°±12.0°，两组间比较均有统计学差异（P<0.05）；术后即刻cSVA、McGs、UCL、NT在两组间无显著差异（P>0.05）。末次随访时两组影像学参数的矫正丢失无显著差异（P>0.05）。术前TIA与年龄存在显著正相关性（r=0.549, P=0.001），与cSVA（r=0.367, P=0.039）、TK（r=0.392, P=0.027）、GK（r=0.366, P=0.039）呈正相关，与UCL（r=-0.591, P<0.001）、CL（r=-0.357, P=0.045）呈负相关。截骨角的大小（ΔLK）与颈椎前凸角的变化之间没有相关性（P>0.05）。结论：与TIA较小的患者相比，TIA大的AS患者术前存在更大的UCL，而LCL没有差别；行腰椎截骨矫形术后，UCL与LCL均减小，但TIA大的AS患者存在更大的LCL，而UCL则没有差别。

英文摘要:

  【Abstract】 Objectives: To investigate the radiographic characteristics of cervical sagittal alignment in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis at different thoracic inlet angles(TIA). Methods: 32 patients who underwent pedicle subtraction osteotomy (PSO) in our hospital from January 2012 to December 2020 with complete data were included. Clinical data including gender, age, osteotomized level, fusion levels were collected. Preoperative, postoperative, the last follow-up radiological parameters consisting of cervical sagittal vertical axis(cSVA), McGregor slope(McGs), upper cervical lordosis(UCL), lower cervical lordosis(LCL), cervical lordosis(CL), C2 slope, C7 slope, T1 slope(T1S), neck tilt(NT), thoracic inlet angle(TIA), global kyphosis(GK), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), and local kyphosis(LK) were measured. Patients were divided into two groups on the basis of TIA value (Group A: TIA<70°; Group B: TIA≥70°). Independent sample t-test or chi-square test was used to compare the difference of clinical data and preoperative parameters between the two groups, and paired sample t-test was used for the comparison of preoperative and postoperative parameters in group A and group B respectively. Pearson correlation analysis was performed to evaluate the correlations between TIA and clinical data and preoperative parameters. Results: There were 15 patients (13 males and 2 females) in group A and 17 patients (13 males and 4 females) in group B. The mean age in group A was 28.5±5.7 years, and that in group B was 37.7±14.4 years. There was significant difference in the age between the two groups(P<0.05). The preoperative cSVA, UCL, CL, TK and GK in group B were 48.0±18.1mm, -22.8°±7.4°, -56.3°±10.9°, 50.1°±9.9° and 69.8°±11.9° respectively, which were greater than those in group A(P<0.05). While no significant difference was observed in preoperative McGs and LCL between the two groups(P>0.05). The postoperative LCL, CL, TK in group B were -20.9°±11.9°, -35.0°±9.4° and 46.2°±12.0° respectively, which were greater than in group A. While there was no significant difference being observed in postoperative cSVA, McGS, UCL and NT between the two groups(P>0.05). The loss of correction at the last follow-up showed no significant difference between the two groups(P>0.05). Preoperative TIA was positively correlated with age(r=0.549, P=0.001), cSVA(r=0.367, P=0.039), TK(r=0.392, P=0.027) and GK(r=0.366, P=0.039). However, TIA was negatively correlated with preoperative UCL(r=-0.591, P<0.001) and CL(r=-0.357, P=0.045). Moreover, no correlation between the change of cervical lordosis and ΔLK was found in both groups(P>0.05). Conclusions: Compared with AS patients with small TIA, AS patients with greater TIA had larger preoperative UCL, whereas there was no difference in LCL. After lumbar PSO, both UCL and LCL decreased. However, AS patients with greater TIA had larger LCL and there was no significant difference concerning UCL.