影响腰椎矢状面平衡的胸腰椎后凸畸形临床影像学研究  

Kyphosis of thoracolumbar spine affect sagittal balance of the lumbar spine:a clinical radiographic study

作　　者：孙建民[1] 丁晓林[2] 崔新刚[1] 蒋振松[1] 

机构地区：[1]山东省立医院,山东济南250021 [2]泰山医学院

出　　处：《山东医药》2007年第15期11-13,共3页Shandong Medical Journal

基　　金：山东省自然科学基金课题(Y2006C128)

摘　　要：目的探讨胸腰椎后凸畸形对腰椎矢状面平衡的影响及其临床意义。方法选择胸腰椎和腰骶椎正侧位X线片有胸腰椎后凸畸形的18例患者（患病组）,应用E-Ruler软件对Cobb角进行测量,就胸腰段后凸Cobb角、顶椎位置、腰椎前凸Cobb角、每一节段腰椎的Cobb角进行分析研究,并与22例正常对照组进行相应比较;根据顶椎的位置患病组进行组内比较。结果患病组全腰椎前凸角度、分节段腰椎前凸角度与正常对照组相比有显著性差异（P〈0.01）。患病组单节段腰椎前凸角度以上腰椎前凸变化更为明显,在L2~3和L3~4分别是正常组相应节段的2.41和1.50倍。患病组后凸顶椎位置多在T12（38.89%）或L1（38.89%）。正常对照组胸腰椎Cobb角为（6.34±3.39）度。结论腰椎过度前凸是胸腰椎后凸畸形后为维持脊柱矢状面平衡的一个重要代偿改变,且畸形以上腰椎的改变更为明显,而顶椎的位置对上腰椎的影响不大。[Objective] To investigate the affect of kyphosis of thoracolumbar spineon sagittal balance of lumbar spine and its clinical significance. [Methods] 18 patients （13 men, 5 women,mean age 31.7 years, ranged from 7 to 59 years） and 22 volunteers（9 men,13 women,mean age 41.55 years,ranged from 14 to 68 years） had the lateral X-ray films of the lumbar and thoracolumbar spine,which were studied by measuring Cobb angle with E-ruler. Cobb angle of thoracolumbar kyphosis, position of apex vertebra, Cobb angle of lumbar lordosis and Cobb angle of every lumbar vertabra were analyzed. And then the results were compared statistically between the normal group and the invalid group. [Results] The average of Cobb angle of the lumbar spine and segmental lambar spine in invalid group were larger than those in normal group（ P 〈 0.01） ,however it was .found that the amount of increased lordosis in the upper part（L2N3,L3-4） of the lumbar spine was more than that in the lower part of the lumbar spine（L4-6 and L5-S1 ）. The Cobb angle of segmental lordosis of L2-3 and L3-4 was 2.41 times and 1.50 times large than that of the corresponding level of the normal spine respectively. Apex vertebras of invalid group most located at T12 （38.89 % ） or L3 （38.89 %）. The average Cobb angle of thoracolumbar spine was 6.34°±3.39°. [Conclusions] Over lordosis of the lumbar spine is main changes secondary to the kyphosis of the thoracolumbar spine. These changes usually maintaine the balance of the whole spine in most conditions,whereas at the same time make great influences on the lumbar spine especially in upper lumber spine. Apex vertcbra positon has little affect on upper lumbar spine.

关 键 词：脊柱后凸 腰椎前凸 COBB角 

分 类 号：R682.1[医药卫生—骨科学]