胸腰椎陈旧性骨折继发后凸畸形致脊柱矢状位生理曲度改变的影像学研究  

Imaging study of sagittal alignment changes caused by post-traumatic kyphosis secondary to old thoracolumbar fractures

作　　者：李良辰[1] 何登伟[1] 梅良伟 黄文君[1] 楼超[1] 朱科军[1] 

机构地区：[1]温州医科大学附属第五医院暨丽水市中心医院骨科,323000

出　　处：《中华创伤杂志》2017年第6期500-504,共5页Chinese Journal of Trauma

基　　金：浙江省自然科学基金（LYl7C100002）;浙江省科技厅公益项目（2016C33245）;浙江省医药卫生科技项目（2014KYB315）

摘　　要：目的比较胸腰椎陈旧性骨折继发后凸畸形患者与正常成人的Roussouly分型情况，评价胸腰椎陈旧性骨折继发不同后凸畸形角度对脊柱矢状位生理曲度的影响，进而为临床明确胸腰椎陈旧性骨折继发后凸畸形患者病情和治疗方案提供理论依据。方法采用回顾性病例对照研究分析2014年1月— 2015年12月因胸腰椎陈旧性骨折继发不同程度后凸畸形患者49例（骨折组）。损伤部位：T11 4例，T12 14例，L1 25例，L2 6例。另外收集52例正常成人志愿者作为对照组。分别进行全脊柱正、侧位X线摄片，对所得X线片按照Roussouly分型标准分型，统计分析两组的Roussouly分型分布的差异。进一步将骨折组患者以Cobb角每改变10°作为一个亚组，统计各亚组的Roussouly分型分布，统计各亚组间的Roussouly分型分布的差异。结果正常脊柱组Roussouly分型结果为1型5例，2型12例，3型25例，4型10例；骨折组Roussouly分型结果为1型14例，2型11例，3型8例，4型16例，两组的Roussouly分型分布差异有统计学意义（P〈0.05）。骨折组以Cobb角分亚组后的Roussouly分型结果为Cobb角0°～10°亚组1、2型2例，3、4型7例；Cobb角10°～20°亚组1、2型4例，3、4型10例；Cobb角20°～30°亚组1、2型12例，3、4型共4例；Cobb角30°～40°亚组1、2型7例，3、4型3例。对骨折组进行亚组分析显示，各组的Roussouly分型分布差异有统计学意义（P〈0.05）。当Cobb角〉20°时，脊柱平衡欠佳的Roussouly 1、2型显著增多（P〈0.05）。结论胸腰椎陈旧性骨折继发后凸畸形可改变脊柱矢状位生理曲度，Cobb角越大，脊柱不平衡的Roussouly 1、2型分布越多。当Cobb角〉20°时，对脊柱矢状位平衡有显著影响，提示脊柱后凸畸形〉20°可能是临床上需要手术干预的参考依据。Objective To compare the Roussouly classification of old thoracolumbar fractures combined with post-traumatic kyphosis with that of normal adults, evaluate the effect of different kyphosis angles on sagittal curvature of the thoracolumbar spine so as to provide a theoretical basis for the clinical status and clinical treatment plan of old thoracolumbar fractures combined with post-traumatic kyphosis. Methods A retrospective case control study was made on 49 cases of old thoracolumbar fractures with post-traumatic kyphosis treated from January 2014 to December 2015 （fracture group ）. Damaged segments of the spine were Tn in four cases, T12 in 14, L1 in 25 and L2 in six. Another 52 normal adult volunteers were chosen as controls. Whole spine X-ray film of the two groups was taken, and the difference in Roussouly classification of the sagittal spine curvature was compared between the two groups. Patients in fracture group were separated into subgroups depending on the Cobb angle （0°-10°, 10°-20°, 20°-30°, 30°-40°, respectively）, and the difference in Roussouly classification was compared among subgroups. Results Roussouly classification in control group was five cases of type 1, 12 tpye 2, 25 type 3 and 10 type 4. Results in fracture group was 14 cases of type 1, 11 type 2, eight type 3 and 16 type 4. There were significant differences in Roussouly types between the two groups （P 〈 0.05）. According to Roussouly classification, there were two cases of types 1 and 2 and seven cases of types 3 and 4 in subgroup of Cobb angle between 0°-10° ; four cases of types 1 and 2 and 10 cases of types 3 and 4 in subgroup of Cobb angle between 10°-20° ; 12 cases of types 1 and 2 and four cases of types 3 and 4 in subgroup of Cobb angle between 20°-30° ; seven cases of types 1 and 2 and three cases of types 3 and 4 in subgroup of Cobb angle between 30°-40°. There were significant differences in Roussouly types among subgroups （P 〈 0.05 ）. Further, Roussouly types 1 and 2 were significantly increa

关 键 词：脊柱后凸 胸椎 腰椎 Roussouly分型 

分 类 号：R687.3[医药卫生—骨科学]