胸弯型和胸腰弯/腰弯型青少年特发性脊柱侧凸患者冠状面与矢状面参数的影像学研究

Imaging study of coronal and sagittal parameters in adolescent idiopathic scoliosis patients with thoracic curve or thoraco-lumbar/lumbar curve

中文关键词:  青少年特发性脊柱侧凸  矢状位参数  冠状位参数  代偿机制

英文关键词:Adolescent idiopathic scoliosis  Sagittal alignment  Coronal alignment  Compensatory mechanisms

中文摘要:

  【摘要】 目的：探讨胸弯型和胸腰弯/腰弯型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者冠状面与矢状面参数的变化，分析两种分型矢状面各参数间的相关性。方法：纳入71例胸弯型和64例胸腰弯/腰弯型AIS患者，根据弯弧位置分为两组，并纳入40例正常青少年作为对照组进行对比研究。所有受试者均拍摄站立位脊柱全长正侧位X线片，使用Surgimap专用软件分别测量矢状面和冠状面相关参数。矢状面参数包括：颈椎前凸角（cervical lordosis，CL）、C2-7矢状位垂直距离（C2-7 sagittal vertical axis，C2-7SVA）、T1斜率（T1 slope）、T1倾斜度（T1 tilt）、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）、C7 矢状位垂直距离（C7 sagittal vertical axis，C7SVA）；冠状面参数包括：主弯Cobb角（major curve Cobb，MCC）、顶椎偏距（apical vertebral translation，AVT）、C7铅垂线与骶骨中垂线的距离（distance between C7 plumb line and the central sacral vertical line，C7PL-CSVL）、T1冠状面斜率（T1 coronal angle，T1CA）、腰椎骨盆关系（lumbar-pelvic relationship，LPR）。采用Pearson相关系数分别检验胸弯组和胸腰弯/腰弯组冠状面与矢状面之间的相关性；采用独立样本T检验或Mann-Whitney U检验进行比较，并使用Pearson进行相关性分析。结果：胸弯组冠状面参数与矢状面参数之间无相关性，胸腰弯/腰弯组结果显示PT与C7PL-CSVL和LPR之间呈显著性相关（r=0.320；r=0.339），其他参数均无相关性。胸弯组与对照组在CL（P＜0.001）和TK（P＜0.001）之间存在显著性差异，而胸腰弯/腰弯组在C2-7SVA（P＜0.001）、PI（P＜0.01）、PT（P＜0.01）和C7SVA（P＜0.01）与对照组之间存在显著性差异。相关性分析显示胸弯组中CL与T1 slope（r=-0.598）和TK（r=-0.602）之间呈负相关；TK与T1 slope（r=0.710）呈正相关；LL与TK（r=-0.495）、PI（r=-0.332）和SS（r=-0.726）呈负相关，与T1 tilt（r=0.342）和C7SVA（r=0.458）呈正相关；C7SVA与T1 tilt（r=0.849）呈正相关；在胸腰弯/腰弯组中CL与T1 slope（r=-0.431）呈负相关；TK与T1 slope（r=0.373）呈正相关；LL与PI（r=-0.339）和SS（r=-0.858）呈负相关，与PT（r=0.319）呈正相关；C7SVA与T1 tilt（r=0.386）和PI（r=0.338）呈正相关。结论：胸弯型和胸腰弯/腰弯型AIS患者冠状面畸形改变与矢状面之间相关性较低；T1斜率（T1 slope）是预测胸弯型AIS患者颈椎与胸椎矢状面平衡的关键，骨盆入射角（PI）在调节胸腰弯/腰弯型AIS患者矢状位正常的脊柱-骨盆位置关系上发挥着重要作用。

英文摘要:

  【Abstract】 Objectives: To investigate the changes of coronal and sagittal plane parameters in adolescent idiopathic scoliosis(AIS) patients with thoracic curve or thoraco-lumbar/lumbar curve, and to analyze the correlation of sagittal parameters between the two types of curve. Methods: 71 AIS patients with thoracic curve and 64 AIS patients with thoraco-lumbar/lumbar curve were divided into two groups according to their types of curve. And 40 normal adolescents were enrolled as the control group. All the subjects took anteroposterior and lateral full-length spine X-rays(standing), and the related coronal and sagittal parameters were measured with Surgimap software. The sagittal plane parameters included cervical lordosis(CL), C2-7 sagittal vertical axis(C2-7SVA), T1 slope, T1 tilt, thoracic kyphosis(TK), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), and C7 sagittal vertical axis(C7SVA). The coronal parameters included major curve Cobb(MCC), apical vertebral translation(AVT), distance between C7 plumb line and the central sacral vertical line(C7PL-CSVL), T1 coronal angle(T1CA), and lumbar pelvic relationship(LPR). Pearson correlation coefficient was used to test the correlation between coronal plane and sagittal plane in thoracic curve group and thoraco-lumbar/lumbar curve group, and independent sample T test or Mann-Whitney U test and Pearson was used to analyze the correlation. Results: There was no correlation between coronal plane parameters and sagittal plane parameters in thoracic curve group. In thoraco-lumbar/lumbar curve group, there was a significant correlation between PT and C7PL-CSVL and LPR(r=0.320, r=0.339), and there was no correlation between other parameters. There were significant differences in CL(P<0.001) and TK(P<0.001) between thoracic curve group and control group, while there were significant differences in C2-7SVA(P<0.001), PI(P<0.001), PT(P<0.001) and C7SVA(P<0.01) between thoraco-lumbar/lumbar curve group and control group. Intra-group analysis showed that in thoracic curve group, CL was negatively correlated with T1 slope(r=-0.598) and TK(r=-0.602), TK was positively correlated with T1 slope(r=0.710), LL was negatively correlated with TK(r=-0.495), PI(r=-0.332) and SS(r=-0.726), and positively correlated with T1 tilt(r=0.342) and C7SVA(r=0.458), while C7SVA was positively correlated with T1 tilt(r=0.849). In thoraco-lumbar/lumbar curve group, CL was negatively correlated with T1 slope(r=-0.431), TK was positively correlated with T1 slope(r=0.373), LL was negatively correlated with PI(r=-0.339) and SS(r=-0.858) and positively correlated with PT(r=0.319), while C7SVA was positively correlated with T1 tilt(r=0.386) and PI(r=0.338). Conclusions: The correlation between coronal deformities and sagittal plane in thoracic curve and thoraco-lumbar/lumbar curve AIS patients is low. T1 slope is the key to predict the sagittal plane balance between cervical and thoracic vertebrae in AIS patients with thoracic curve. Pelvic incidence plays an important role in regulating the normal spino-pelvic position relationship in AIS patients with thoraco-lumbar/lumbar curve.