终末期原发髋关节骨关节炎患者脊柱-骨盆矢状面形态异常及其与腰痛关系的初步研究

目的探讨终末期原发髋关节骨关节炎（HOA）患者在脊柱-骨盆矢状面上的形态与伴随的腰痛症状的关系。方法收集46例HOA患者及55例正常对照的立位全脊柱侧位X线片,测量腰椎前凸角（LL）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、骨盆投射角（PI）、脊柱骶骨角（SSA）、脊柱前倾角（ST）;将HOA患者根据是否存在腰痛分为无腰痛组（23例）和有腰痛组（23例）,对后者的腰痛进行评分（VAS）。应用独立样本的t检验比较HOA患者与正常人的各个参数,并采用非参数检验比较HOA亚组间及其与正常对照的差异;将HOA患者的各个参数与VAS评分进行相关性分析。结果原发性HOA组和正常人组的年龄及性别分布无统计学差异,两组的LL分别为（45.2°±17.3°和51.1°±8.5°,t=-2.627,P〈0.05）;ST分别为（87.8°±8.3°和94.5°±3.0°,t=-6.652,P〈0.01）,组间差异有统计学意义,两组间的SS、PT、PI及SSA无统计学差异。与正常对照组相比,HOA腰痛组的LL（39.4°±19.47°,t=-4.260,P〈0.05）、SSA（121.5°±13.5°,t=-3.287,P〈0.05）和ST（87.6°±8.0°,t=-6.478,P〈0.05）均明显偏小,差异有统计学意义;而无腰痛组的SS（42.1°±11.1°,t=3.496,P〈0.05）明显偏大、PT（10.3°±8.8°,t=-2.466,P〈0.05）及ST（88.1°±8.8°,t=-5.678,P〈0.05）明显偏小,差异有统计学意义,其他参数间无明显差异。相关性分析显示HOA患者的腰痛VAS评分与LL、SS、PT之间存在明显相关性（P〈0.05）。结论 HOA患者存在脊柱-骨盆的矢状面形态异常,表现为较正常人腰椎前凸减小、脊柱前倾增加。与正常对照相比,无腰痛HOA患者骨盆及脊柱均前倾,但腰椎前凸无明显减小;有腰痛的HOA患者骨盆无明显前倾,但腰椎前凸减小,脊柱前倾增加。这些结果表明HOA患者的腰痛可能与其腰椎矢状面形态改变存在一定的联系。

Preliminary study of spinal-pelvic sagittal alignment and its relationship with lumbar pain in patients with end-stage primary hip osteoarthritis

Objective To discuss the correlation between the spinal-pelvic sagittal alignment and the lower back pain（LBP） in the patients with end-stage primary hip osteoarthritis（HOA）.Methods The up-right standing lateral X-ray films of the spine and pelvis were taken from 46 patients with primary HOA and 55 normal controls.The lumbar lordosis（LL）,sacral slope（SS）,pelvic tilt（PT）,pelvic incidence（PI）,spinal sacral angle（SSA）,and spinal tilt（ST） were measured.The patients with HOA were divided into two subgroups based on LBP（23 cases in each subgroup）,and the LBP was assessed by visual analogue score（VAS）.The comparison between HOA patients and normal controls were performed by independent-samples t test while the subgroups and the normal-control group were compared by nonparametric t test.The correlations between VAS and the measured parameters were analysed in the patients with HOA.The statistical significance was defined as P〈0.05.Results There was no significant difference in neither age or gender distribution between the HOA patients and the normal controls.The HOA patients showed significant lower LL（45.2° ± 17.3° vs 51.1° ± 8.5°,t =-4.260,P〈0.05） and ST（87.8° ± 8.3° vs 94.5° ± 3.0°,P〈0.01） but no difference in SS,PI,PI and SSA when compared to the normal controls.The patients with LBP showed significantly smaller LL（39.4° ± 19.7°,t =-4.260,P〈0.05）,SSA（121.5° ± 13.5°,t =-3.287,P〈0.05） and ST（87.6° ± 8.0°,t =-6.478,P〈0.05）compared to the normal controls,while the patients without LBP showed significant larger SS（42.1° ±11.1°,t = 3.496,P〈0.05） but smaller PT（10.3° ± 8.8°,t =-2.466,P〈0.05） and ST（88.1° ±8.8°,t =-5.678,P〈0.05）.In addition,the significant correlations were retrieved between the VAS scores and LL,SS and PT in the patients with HOA（P〈0.05）.Conclusions Abnormal spinal-pelvic sagittal alignment was found in the patients with HOA,presenting with decreased lumbar lordosis but increased fo