弥漫性特发性骨肥厚症患者立-坐位脊柱－骨盆矢状面参数变化特征

Change characteristics of standing-sitting spinopelvic sagittal parameters in patients with diffuse idiopathic skeletal hyperostosis

中文关键词:  弥漫性特发性骨肥厚症  异常骨增生  脊柱骨盆矢状位参数  脊柱骨盆活动度

英文关键词:Diffuse idiopathic skeletal hyperostosis  Bone hyperplasia  Spinopelvic sagittal parameters  Spinopelvic mobility

中文摘要:

  【摘要】 目的：探讨弥漫性特发性骨肥厚症（diffuse idiopathic skeletal hyperostosis，DISH）患者胸腰椎异常骨增生对立-坐位脊柱-骨盆矢状面参数的影响。方法：回顾性分析2019年1月～2023年12月因腰椎管狭窄症在我院接受手术治疗的61例DISH患者（DISH组）的资料，男４２例，女１９例；年龄５０~７６岁（６５.１±６.３岁）。选取同期年龄及性别匹配且接受相同术式治疗的100例非DISH腰椎管狭窄症患者作为对照组（N-DISH组），男６３例，女３７例；年龄５４~７７岁（６７.５±７.２岁）。根据骨赘分布，将DISH组中异位骨化仅累及胸椎的患者纳入T-DISH组，将异位骨化同时累及胸椎和腰椎的患者纳入L-DISH组。术前分别于站立和坐位下拍摄全脊柱正侧位X线片，测量所有患者立位和坐位时的脊柱-骨盆矢状位参数，包括矢状面偏移（sagittal vertical axis，SVA）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜度（sacral slope，SS）、骨盆入射角（pelvic incidence，PI）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）和股骨近端角（proximal femoral angle，PFA），比较DISH组与N-DISH组、T-DISH组与L-DISH组立、坐位时及变化的差异。结果：在立位下，DISH组的SVA（P=0.008）和TK（P=0.028）均显著性高于N-DISH组，而PI、PT、SS、LL及PFA两组间均无统计学差异（P>0.05）；在坐位下，DISH组的TK（P=0.003）和LL（P=0.007）均显著性高于N-DISH组，而SVA、PT、PI、SS及PFA两组间无显著性差异（P>0.05）；当从立位变化到坐位时，DISH组患者SVA（P=0.021）、PT（P=0.008）、SS（P=0.001）、TK（P=0.002）和LL（P<0.001）的变化值显著性小于N－DISH组患者。在DISH患者中，L-DISH组的PI（P=0.016）、SS（P=0.011）和LL（P=0.006）在立位时显著性小于T-DISH组，SVA、PT、TK及PFA与T-DISH组比较无显著性差异（P>0.05）；在坐位时PI（P= 0.008）和SS（P=0.007）显著性小于T-DISH组，SVA、PT、TK、LL及PFA与T-DISH组比较无显著性差异（P>0.05）；当由立位转变为坐位时，L-DISH组LL的变化值显著性低于T-DISH组（P=0.033），其余矢状位参数变化值与T-DISH组比较无显著性差异（P>0.05）。结论：ＤＩＳＨ患者异常骨增生显著限制了脊柱的活动度，与单纯胸段DISH患者相比，骨赘发展至腰椎节段的患者受到的限制更明显。

英文摘要:

  【Abstract】 Objectives: To investigate the impact of bone hyperplasia in the thoracolumbar spine caused by diffuse idiopathic skeletal hyperostosis(DISH) on the changes of spinopelvic sagittal parameters between standing and sitting positions. Methods: A total of 61 DISH patients[DISH group, 42 males and 19 females, 50-76(65.1±6.3) years] who underwent surgical treatment for lumbar spinal stenosis in our hospital between January 2019 and December 2023 were retrospectively analyzed. 100 age- and sex-matched non-DISH patients undergone the same surgical procedure during the same period were included as control[N-DISH group, 63 males and 37 females, 54-77(67.5±7.2) years]. According to the distribution of osteophytes, the patients in the DISH group with ectopic ossification limited to the thoracic spine were categorized into the T-DISH group, while those with involvement of both thoracic and lumbar spines were divided in the L-DISH group. Preoperatively, full-spine anteroposterior and lateral X-rays were taken in both standing and sitting positions. All patients were measured for spinopelvic sagittal parameters in standing and sitting positions, including sagittal vertical axis(SVA), pelvic tilt(PT), sacral slope(SS), pelvic incidence(PI), thoracic kyphosis(TK), lumbar lordosis(LL), and proximal femoral angle(PFA). The differences in standing and sitting positions and changes between DISH and N-DISH groups, T-DISH and L-DISH groups were compared. Results: In the standing position, the SVA(P=0.008) and TK(P=0.028) in the DISH group were significantly higher than those in the N-DISH group, while no significant differences were observed in PI, PT, SS, LL, and PFA(P>0.05). In the sitting position, the TK(P=0.003) and LL(P=0.007) in the DISH group were significantly higher than those in the N-DISH group, whereas no significant differences were noted inSVA, PT, PI, SS, and PFA(P>0.05). When transitioning from standing to sitting, the changes in SVA(P=0.021), PT(P=0.008), SS(P=0.001), TK(P=0.002), and LL(P<0.001) in DISH group of patients were significantly smaller than those in N-DISH group of patients. Among DISH patients, the L-DISH group had significantly lower PI(P=0.016), SS(P=0.011), and LL(P=0.006) in the standing position compared to the T-DISH group, while no significant differences were observed in SVA, PT, TK, and PFA(P>0.05). In the sitting position, the PI(P=0.008) and SS(P=0.007) of the L-DISH group were significantly lower than those of the T-DISH group, while no significant differences were observed in SVA, PT, TK, LL, and PFA(P>0.05). The changes in LL when transitioning from standing to sitting were significantly lower in the L-DISH group compared to the T-DISH group(P=0.033), while the changes of other sagittal parameters showed no significant difference(P>0.05). Conclusions: Bone hyperplasia in DISH patients significantly limits spinal mobility, and the restriction is more pronounced in patients with osteophytes extending to the lumbar spine compared to those with isolated thoracic involvement.