顶椎位置对退变性脊柱后凸患者矢状面形态及生活质量的影响

Effects of kyphotic apical vertebra position on the sagittal plane morphology and quality of life in patients with degenerative kyphosis

中文关键词:  退变性脊柱后凸畸形  后凸顶椎  生活质量  矢状面形态

英文关键词:Degenerative kyphosis  Kyphotic apical vertebra  Health related quality of life  Sagittal alignment

中文摘要:

  【摘要】 目的：分析后凸顶椎（kyphotic apical vertebra，KAV）位置对退变性脊柱后凸（degenerative kyphosis，DK）患者矢状面特征和生活质量的影响。方法：回顾分析2010年2月~2022年12月在南京鼓楼医院骨科住院治疗的68例DK患者的临床及影像学资料。男性8例，女性60例，年龄46~76岁（60.6±6.5岁）。根据KAV位置不同将患者分为两组：KAV位于L1及以上的38例患者纳入G1组；KAV位于L1以下的30例患者纳入G2组。在术前站立位全脊柱侧位X线片上测量胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、矢状面垂直轴（sagittal vertical axis，SVA）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、T1骨盆角（T1-pelvic angle，TPA）、最大后凸Cobb角（global kyphosis，GK），计算PI-LL。采用国际脊柱侧凸研究学会（Scoliosis Research Society，SRS）-22量表、Oswestry功能障碍指数（Oswestry disability index，ODI）量表、疼痛视觉模拟量表（visual analog scale，VAS）评分以及SF-36量表评估患者生活质量。采用独立样本t检验比较两组患者的矢状面参数和生活质量问卷评分的差异，采用Pearson相关性分析研究矢状面参数与生活质量评分的相关性。结果：两组患者的年龄和性别比无显著性差异（P>0.05），具有可比性。G1组GK、LL、TK、SVA、PI、PT、SS、TPA、PI－LL分别为61.3°±20.0°、26.9°±18.9°、32.3°±19.0°、53.5±48.1mm、40.4°±13.4°、24.8°±12.6°、17.0°±11.7°、23.0°±13.5°和21.6°±15.6°，G2组分别为38.8°±16.0°、14.4°±13.7、10.8±9.8°、96.5±67.8mm、44.8°±16.2°、30.1°±10.8°、14.7°±11.5°、32.6°±14.5°和33.8°±18.3°，G1组的GK、LL、TK显著性大于G2组（P<0.05），SVA、TPA、PI-LL显著性小于G2组（P<0.05）；G1组VAS评分、ODI、SF-36生理功能总分（physical component score，PCS）、SF-36心理功能总分（mental component score，MCS）和SRS－22评分（功能情况、疼痛、自我形象、心理状况和亚总分）分别为4.2±1.6分、（37.9±15.2）%、45.8±11.3、48.6±12.7、（17.6±4.6、18.6±4.3、17.7±4.5、17.8±4.9、71.7±9.3），G2组分别为5.8±1.7分、（48.6±20.0）%、38.2±12.9、44.2±13.1、（15.6±4.5、16.0±3.6、16.6±4.9、17.1±4.3、65.4±11.1），G1组VAS评分、ODI显著性低于G2组（P<0.05）；G1组SRS-22量表亚总分、疼痛评分、SF-36 PCS评分显著性高于G2组（P<0.05）。Pearson相关性分析结果显示两组SVA与VAS评分和ODI均正相关（G1组r=0.437，P=0.006和r=0.356，P=0.028，G2组r=0.405，P=0.027和r=0.408，P=0.025），与SF-36 PCS评分均负相关（G1组r=-0.365，P=0.024，G2组r=-0.410，P=0.024）；TPA与VAS评分均正相关（G1组r=0.343，P=0.035，G2组r=0.369，P=0.045）。G2组SVA与SRS-22量表亚总分负相关（r=-0.391，P=0.033），PI-LL与VAS评分正相关（r=0.390，P=0.033）。结论：KAV位置会显著影响DK患者的骨盆-脊柱矢状面形态，KAV位于L1以下的患者SVA、TPA、PL-LL明显大于KAV位于L1及以上的患者，且与患者的生活质量下降显著性相关。

英文摘要:

  【Abstract】 Objectives: To analyze the impact of the kyphotic apical vertebra(KAV) position on sagittal plane characteristics and quality of life in patients with degenerative kyphosis(DK). Methods: A retrospective analysis was conducted on the clinical and imaging data of 68 DK patients hospitalized and treated in the Department of Orthopedic Surgery, Nanjing Drum Tower Hospital from February 2010 to December 2022. There were 8 males and 60 females, aged 46-76 years old(60.6±6.5 years). The patients were divided into two groups based on the position of the KAV: Group 1(G1) included 38 patients with the KAV at or above L1, and Group 2(G2) included 30 patients with the KAV below L1. The thoracic kyphosis(TK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), T1-pelvic angle(TPA), and global kyphosis(GK) were measured on standing full-spine lateral X-rays before operation, and the value of PI-LL was calculated. Health related quality of life(HRQoL) was assessed using the Scoliosis Research Society-22(SRS-22) questionnaire, Oswestry disability index(ODI), visual analog scale(VAS) score, and SF-36 questionnaire. Independent samples t-tests were used to compare sagittal plane parameters and HRQoL scores between the two groups. Pearson correlation analysis was employed to examine the relationship between sagittal plane parameters and HRQoL scores. Results: There was no significant difference in the age and sex ratios between the two groups(P>0.05). The GK, LL, TK, SVA, PI, PT, SS, TPA, and PI-LL in G1 group were respectively 61.3°±20.0°, 26.9°±18.9°, 32.3°±19.0°, 53.5±48.1mm, 40.4°±13.4°, 24.8°±12.6°, 17.0°±11.7°, 23.0°±13.5°, and 21.6°±15.6°, which in G2 group were 38.8°±16.0°, 14.4°±13.7, 10.8±9.8°, 96.5±67.8mm, 44.8°±16.2°, 30.1°±10.8°, 14.7°±11.5°, 32.6°±14.5°, and 33.8°±18.3°. The GK, LL, and TK were significantly greater in G1 group than those in G2 group(P<0.05), and SVA, TPA, and PI-LL were less in G1 group than those in G2 group(P<0.05). The VAS score, ODI, SF-36 physical component score(PCS), SF-36 mental component score(MCS), SRS-22(function, pain, self-image, mental health, subtotal score) in G1 group were 4.2±1.6, (37.9±15.2)%, 45.8±11.3, 48.6±12.7, and (17.6±4.6, 18.6±4.3, 17.7±4.5, 17.8±4.9, 71.7±9.3), which were 5.8±1.7, (48.6±20.0)%, 38.2±12.9, 44.2±13.1, and (15.6±4.5, 16.0±3.6, 16.6±4.9, 17.1±4.3, 65.4±11.1) in G2 group. G1 group was lower in VAS score and ODI significantly(P<0.05) and higher in SRS-22 subtotal score, SRS-22 pain domain score, and SF-36 PCS significantly(P<0.05) than G2 group. Pearson correlation analysis showed that SVA was positively correlated with VAS and ODI in both groups(G1 group: r=0.437, P=0.006 and r=0.356, P=0.028; G2 group: r=0.405, P=0.027 and r=0.408, P=0.025), while negatively correlated with SF-36 PCS(G1 group: r=-0.365, P=0.024; G2 group: r=-0.410, P=0.024). TPA was positively correlated with VAS score in both groups(G1 group: r=0.343, P=0.035; G2 group: r=0.369, P=0.045). In G2 group, SVA negatively correlated with SRS-22 subtotal score(r=-0.391, P=0.033), and PI-LL was positively correlated with VAS score(r=0.390, P=0.033). Conclusions: The position of KAV affects the pelvic-spinal sagittal alignment obviously in DK patients, and the patients with KAV located below L1 level have significantly higher SVA, TPA, and PI-LL compared to the patients whose KAV located at or above L1 level, which is significantly associated with decreased quality of life.