腰椎退行性侧凸患者脊柱矢状位参数与骨盆参数的相关性

目的 探讨不同类型腰椎退行性侧凸患者脊柱矢状位参数与骨盆参数的相关性.方法 70名脊柱形态正常的志愿者与110例腰椎退行性侧凸患者,摄站立位脊柱全长正侧位X线片,测量胸椎后凸角、胸腰段后凸角、腰椎前凸角、矢状位垂直轴、骨盆投射角、骶骨倾斜角和骨盆倾斜角.根据SRS测量标准,将腰椎退行性侧凸患者按脊柱矢状位形态分为三型:Ⅰ型45例、Ⅱ型48例、Ⅲ型17例.比较志愿者与各型退变侧凸组间的脊柱矢状位参数及骨盆参数,分析脊柱矢状位参数与骨盆参数的相关性.结果 骨盆投射角,Ⅲ型退行性侧凸组低于其他三组,差异有统计学意义；骨盆倾斜角,Ⅱ型、Ⅲ型退行性侧凸组高于志愿者组及Ⅰ型退行性侧凸组,差异有统计学意义,其中Ⅱ型与Ⅲ型的差异也有统计学意义；骶骨倾斜角,Ⅱ型、Ⅲ型退行性侧凸组小于志愿者组及Ⅰ型退行性侧凸组,差异有统计学意义.在志愿者组、Ⅰ型退行性侧凸组中未发现脊柱矢状位失平衡；Ⅱ型与Ⅲ型退行性侧凸组脊柱矢状位失平衡的发生率分别为17.8％、29.4％.志愿者组与Ⅰ型退行性侧凸组的脊柱矢状位参数间、骨盆参数间及矢状位脊柱-骨盆参数间存在相关性；Ⅱ、Ⅲ型退行性侧凸组的脊柱矢状位参数间的相关性逐渐减小,矢状位脊柱-骨盆参数间的相关性也减小甚至消失,而骨盆参数间的相关性存在；各型退行性侧凸组的腰椎前凸角、骨盆倾斜角均与矢状位垂直轴相关,其中后两者的相关性更大.结论 脊柱矢状位形态呈阶梯样改变,Ⅱ、Ⅲ型退行性侧凸患者的骨盆参数、脊柱矢状位参数与骨盆参数的相关性发生变化,更容易出现脊柱矢状位失平衡.

Correlation between sagittal spinal and pelvic parameters in degenerative lumbar scoliosis

Objective To investigate the correlation between sagittal spinal and pelvic parameters in different types of degenerative lumbar scoliosis (DLS). Methods Standing anteroposterior and lateral radiographs of the whole spine including hip joints were carried out in 70 volunteers without spinal deformity and 110 patients with DLS. The following parameters were measured: thoracic kyphosis (TK), thoracolumbar kyphosis (TL), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS). According to the sagittal spinal alignment, the patients with DLS were classified into 3 types: type Ⅰ (45 cases), type Ⅱ(48 cases) and type Ⅲ (17 cases). The sagittal spinal and pelvic parameters were compared between control group and different types of DLS group, and the relationship between the sagittal spinal parameters and pelvic parameters in different groups were also investigated. Results PI in type Ⅲ patients was lower than those in other groups; PT in type Ⅱ and Ⅲ patients was higher than those in controls and type Ⅰ patients, and there was a significant difference between type Ⅱ and Ⅲ patients; SS in type Ⅱ and Ⅲ patients was lower than those in controls and type Ⅰ patients, and there was no significant difference between type Ⅱ and Ⅲ patients. Sagittal spinal imbalance was found in 17.8% of type Ⅱ patients and 29.4% of type Ⅲ patients. There were significant correlations in sagittal spinal parameters, pelvic parameters and spinopelvic parameters in controls and type Ⅰ patients. However, in type Ⅱ and Ⅲ patients, the correlations in sagittal spinal parameters and spinopelvic parameters decreased, even disappeared, though significant correlations were still found in pelvic parameters. In any group, SVA showed a significant correlation with LL and PT, especially with PT. Conclusion The sagittal spinal alignment has a ladder-like change in patients with DLS, and the correlations in pelvic parameters and spinopelvic parameters also change in type Ⅱ and Ⅲ patients, for whom the sagittal spinal imbalance is more likely to occur.