脊柱-骨盆曲线和谐角在脊柱畸形矢状面评价中的应用  

Sagittal balance evaluation of spinal deformities using curve harmony angles

作　　者：刘辉[1] 郑召民[1] 李思贝 张奎渤[2] 王建儒[1] 王华锋[1] 王华[1] 李泽民[1] 杨豪[1] 

机构地区：[1]中山大学附属第一医院脊柱外科,广州510080 [2]广州中山大学附属第五医院脊柱外科

出　　处：《中华骨科杂志》2014年第8期831-838,共8页Chinese Journal of Orthopaedics

基　　金：广东省自然科学基金自由申请项目（$2013010015397）;中山大学附属第一医院优秀青年人才支持计划（2012-2017）

摘　　要：目的探讨脊柱一骨盆曲线和谐角（curveharmonyangle，CHA）在量化矢状面相邻弯曲间相关性的作用，并评估其用于评价脊柱畸形矢状面平衡的可行性。方法收集93名正常志愿者及95例脊柱畸形患者（包括退变性脊柱侧凸、特发性脊柱侧凸及强直性脊柱炎）的影像学资料，测量常见脊柱-骨盆矢状面局部参数和整体参数，并对其进行相关分析。测量脊柱-骨盆曲线和谐角，包括颈胸和谐角（cervical-thoracicangle，CTA）、胸腰和谐角（thoracic．1umbarangle，TLA）和腰骶和谐角（1umbar．sacralangle，LSA），比较正常人及不同畸形患者间CHA的特征性改变。根据Schwab．SRS成人脊柱畸形分型矢状面参数进行分组，比较不同矢状面平衡状态下CHA的改变，以检验CHA评价脊柱畸形矢状面平衡的可行性。结果正常志愿者与各类型脊柱畸形患者常用脊柱骨盆参数呈现典型改变。CHA在不同类型的脊柱畸形中呈特征性改变。与正常组比较，退变性脊柱侧凸组与强直性脊柱炎组均表现CTA与LSA减小、TLA增大，且强直性脊柱炎组变化程度更为显著；特发性侧凸组仅TLA减小，而CTA及LSA与正常组的差异无统计学意义。矢状面代偿平衡组较平衡组有较小的LSA，失衡组较平衡组有较小的CTA与LSA和较大的TLA，CHA能反映各代偿阶段的特征性改变。结论CHA可用于量化描述矢状面相邻弯曲间的关系。正常人、各类型脊柱畸形、以及不同平衡状态下CHA表现出不同的特点，其用于临床矢状面平衡及畸形矫正效果的评估具有可行性。Objective To introduce Curve Harmony Angle （CHA） to quantify the relationship between adjacent curves of the spine and pelvis and evaluate sagittal balance in spinal deformities. Methods Radiographic analysis of 93 asymptomatic vol- unteers and 95 patients including Degenerative Scoliosis （DS）, Adolescent Idiopathic Scoliosis （AIS） and Ankylosing Spondylitis （AS） was performed by measuring sagittal paa：ameters. Correlation study among parameters was further conducted. Curve Harmony Angles （CHAs） including the following three parameters were measured. Cervical-Thoracic Angle （CTA）, Thoracic-Lumbar Angle （TLA） and Lumbar-Sacral Angle （LSA）. Comparative study between normal population and different spinal disorders were per-formed in order to describe the characteristic changes of CHAs. Besides, according to Schwab SRS adult deformity classification, comparative study of CHAs in different balance status was performed to test the reliability of CHA on sagittal balance evaluation. Results All subjects showed typical changes of sagittal parameters. Different spinal disorders showed characteristic patterns of CHAs. In Schwab-SRS Adult Deformity Classification, Compensatory Balance group showed smaller LSA compared to Balance group; Imbalance group showed significantly smaller CTA, LSA and significantly greater TLA. Conclusion CHAs are parame- ters used to quantify the relationship between adjacent curves. Comparative study of CHA between normal population and different spinal disorder or among different balance status showed specific characters respectively. It is feasible to use CHA to evaluate the clinical sagittal balance and the results of deformity correction.

关 键 词：脊柱弯曲 姿势平衡 放射摄影术 

分 类 号：R687.3[医药卫生—骨科学]