退变性腰椎侧凸椎间盘退变与矢状面平衡参数的相关性分析  

Correlation analysis between degenerative lumbar scoliosis-intervertebral disc degeneration and sagittal balance parameters

作　　者：张帅[1] 吴海龙[1] 田振峰[1] 武建忠[1] 张立兴[1] 何兰琦 尹明贵 ZHANG Shuai;WU Hailong;TIAN Zhenfeng;WU Jianzhong;ZHANG Lixing;HE Lanqi;YIN Minggui(The First Hospital of Shijiazhuang City,Shijiazhuang 050000,Hebei,China;Lingshou County Hospital,Shijiazhuang 050500,Hebei,China)

机构地区：[1]河北省石家庄市第一医院,河北石家庄050000 [2]河北省灵寿县医院,河北灵寿050500

出　　处：《现代中西医结合杂志》2019年第25期2755-2759,2764,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省医学科学研究重点课题指令计划项目(20150161);河北省科技计划自筹经费项目(152777173)

摘　　要：目的分析退变性腰椎侧凸矢状面平衡参数的特点及其与椎间盘退变的相关性,探讨矢状面失衡在退变性腰椎侧凸发生及发展中的作用及意义。方法回顾分析90例退变性腰椎侧凸患者(病例组)的影像学资料,与同时期、同年龄段及同性别比诊断为腰椎退变性疾病而无腰椎侧凸的55例患者(对照组)的影像学资料进行对照比较。所有患者均行脊柱全长X射线及腰椎MRI检查,同时填写ODI、VAS及SRS-22总分量表。采用Image J软件测量矢状面平衡参数:脊柱参数[脊柱矢状轴(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)]、骨盆参数[骨盆入射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)]、脊柱-骨盆参数[T1骨盆角(TPA)、L1骨盆角(LPA)]。采用Adobe Photoshop 6.0软件测量MRI T2加权像矢状面椎间盘与相邻脑脊液的相对信号强度(RSI)。比较2组患者的各节段椎间盘髓核的相对信号强度及各矢状面平衡参数,分析椎间盘退变与矢状面平衡参数的相关性。结果2组患者L 1—5各椎间盘髓核的相对信号强度参数比较差异无统计学意义(P均>0.05);L 5—S 1椎间盘髓核的相对信号强度参数差异有统计学意义(P<0.05)。2组患者矢状面整体平衡参数(SVA、TK、PI、PT、TPA)差异无统计学意义(P均>0.05);局部平衡参数(SS、LL、LPA)差异有统计学意义(P均<0.05)。2组患者ODI、VAS及SRS-22总分差异有统计学意义(P均<0.05)。直线相关及多元回归分析显示,ODI、VAS及SRS-2总分与腰椎矢状面局部平衡参数SS、LL及LPA均有显著相关性(P均<0.05)。L 5—S 1椎间盘退变与矢状面局部平衡参数LL呈负相关(P<0.05);与SS及LPA均呈正相关(P均<0.05)。结论退变性腰椎侧凸患者腰椎矢状面局部失衡及L 5—S 1椎间盘退变程度较重,严重影响患者的生存质量;L 5—S 1椎间盘退变对腰椎矢状面局部平衡参数(LL、SS、LPA)有显著影响,是引起腰椎矢状面局部失衡的重要因素。Objective It is to analyze the characteristics of the sagittal plane balance parameters of degenerative lumbar scoliosis and its correlation with intervertebral disc degeneration,and to explore the role and significance of sagittal imbalance in the occurrence and development of degenerative lumbar scoliosis.Methods A retrospective analysis of image data of 90 cases of degenerative lumbar scoliosis patients(case group)was performed.The imaging data of 55 patients diagnosed as lumbar degenerative diseases(excluding lumbar scoliosis)at the same period and had the same age and sex ratio as the case group were used as a control group.All patients underwent full-length X-ray and lumbar spine MRI,and filled in ODI,VAS and SRS-22 total subscales.Image J software was used to measure sagittal balance parameters:spinal parameters:[spinal sagittal axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL)],pelvic parameters:[pelvic angle of incidence(PI),sacral tilt angle(SS),pelvic tilt angle(PT)],spine-pelvic parameters:[T1 pelvic angle(TPA),L1 pelvic angle(LPA)].The relative signal intensity(RIR)of MRI T2-weighted sagittal disc and adjacent cerebrospinal fluid was measured by Adobe Photoshop 6.0 software.The relative signal intensity of the intervertebral disc nucleus and the sagittal balance parameters of each segment of the two groups were compared,and the correlation between intervertebral disc degeneration and sagittal balance parameters was analyzed.Results There was no significant difference in the relative signal intensity parameters of L 1—5 intervertebral disc nucleus between the two groups(P>0.05).The relative signal intensity parameters of L 5—S 1 intervertebral disc nucleus were statistically significant between the two groups(P>0.05).There were no significant differences in the sagittal overall balance parameters(SVA,TK,PI,PT,TPA)between the two groups(P>0.05).The differences in local balance parameters(SS,LL,LPA)were statistically significant between the two groups(P<0.05).).There were significant differences i

关 键 词：椎间盘退变 矢状面平衡 腰椎侧凸 脊柱失衡 

分 类 号：R681.53[医药卫生—骨科学]