腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性  

Correlation of lumbar disc degeneration and spinal-pelvic sagittal balance

作　　者：刘辉[1] 希腊本大 郑召民[1] 王建儒[1] 杨豪[1] 李泽民[1] 王太平[3] 王华[1] 乌扎布[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080 [2]尼泊尔B&B医院骨科 [3]成都市第二人民医院骨科

出　　处：《中华医学杂志》2013年第15期1123-1128,共6页National Medical Journal of China

摘　　要：目的探讨各节段腰椎间盘退变与矢状面平衡各参数之间的关系。方法回顾性分析2009年7月至2012年6月腰椎退行性疾病患者随访资料共126例，其中摄有脊柱全长正侧位片者38例，仅摄有腰椎正侧位者88例，所有病例均摄有腰椎MRI片。采用ImageJ软件测量以下脊柱-骨盆矢状面参数：（1）脊柱参数：矢状面躯干偏移（SVA）、胸椎后凸角（TK）、胸腰后凸角（TLK）、腰椎前凸角（LL）；（2）骨盆参数：骨盆投射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）；（3）脊柱-骨盆整体参数：T1脊柱骨盆倾斜角（T1-SPI）、T9脊柱骨盆倾斜角（T9-SPI）、脊柱-骶骨角（SSA）、脊柱-骨盆角（SPA）、C7倾斜角（C7T）。根据椎间盘Pfirrmann分级系统，将各节段椎间盘退变等级分级记录。以矢状面平衡各参数的测量数值与常模的大小关系及椎间盘退变等级为依据进行分组，比较各节段椎间盘退变等级与矢状面平衡参数问的关系。结果PI对L5／S1椎间盘退变程度具有显著影响。L5／S1退变程度对矢状面平衡影响显著。大PI组57例中，L5／S1椎间盘轻一中度和重度退变组LL为（36．9±14．9）和（29．7±11．3），差异有统计学意义（P=0．045）；PT为（18．8±8．3）和（25．2±10．2），差异有统计学意义（P=0．012）；SS为（39．5±8．8）和（34．6±8．9），差异有统计学意义（P=0．042）；SVA为（23．0±26．6）和（62．2±33．8），差异有统计学意义（P：0．002）；C7T为（88．9±3．1）和（84．0±4．6），差异有统计学意义（P=0．003）；SPA为（157．9±11．2）和（147．8±14．0），差异有统计学意义（P=0．043）。L1／2椎间盘轻-中度和重度退变组TLK为（4．6±7，8）和（14．9±14．8），差异有统计学意义（P=0．026）。L1／2，L2／3，L3／4退变程度对SPA有显著影响。L1／2两组SPA为（158．5±12．0）和（147．8±12Objective To elucidate the relationship between spino-pelvic sagittal balance parameters and lumbar intervertebral disc degeneration of each segment through retrospective analysis in lumbar degeneration patients. Methods Retrospective analysis was conducted for the follow-up data in 126 patients with lumbar degenerative disease from July 2009 to June 2012. There were 38 cases with whole spine plates and 88 cases with lumbar plates. All of them received magnetic resonance imaging （MRI）scans. Through software Image J, the following spino-pelvic sagittal balance parameters were measured： sagittal vertical axis （SVA, distance between C7 plumb line and posterior upper corner of S1 endplate）, thoracic kyphosis （TK, T5-T12 Cobb angle）, thoracolumbar kyphosis （TLK, T10-L2 Cobb angle）, lumbar lordosis （ LL, L1-L5 Cobb angle）, pelvic incidence （ PI）, pelvic tilt （ PT）, sacral slope （ SS）, T1 spino- pelvic inclination （T1-SPI）, T9 spino-pelvic inclination （T9-SPI）, spino-sacral angle （SSA）, spino-pelvic angle （SPA） and C7 tilt （CTT）. Based on the grading system of Pfirrmann et al, the intervertebral disc degeneration grades were acquired for each lumbar segment. According to the normal range of previous studies, each spino-pelvic sagittal balance parameter was classified into 3 groups, i. e. Group A （less than normal）, Group B （normal） and Group C （more than normal）. All statistical analyses were performed to compare the differences of each lumbar segment/intervertebral disc degeneration among groups by one-way ANOVA test via SPSS 18.0. And P-value 〈 O. 05 was deemed significant. Results PI had a significant impact on the LS/S1 disc degeneration. And I_5/S1 disc degeneration had a significant impact on sagittal balance. Among 57 cases of large PI, LL, PT, SS, SVA, C7T, SPA in I-5/S1 of mild-to-moderate and severe degeneration groups was 36. 91 ±14. 93 and 29. 71 ±11.30 （P =0.045）, 18.82 ±8.27 and 25.18±10.19 （P=0.012）, 39.45±8.82and34.57＋8.88

关 键 词：椎间盘 平衡 腰椎 脊柱-骨盆矢状面平衡参数 

分 类 号：R6[医药卫生—外科学]