成人脊柱侧凸患者长时间行走后矢状面失平衡的动态评估  

Dynamic evaluation of sagittal imbalance after a long walk in adult scoliosis patients

作　　者：尹佳 张珂 马骁 李唐波 高瑞[1] 周许辉[1] YIN Jia;ZHANG Ke;MA Xiao;LI Tang-bo;GAO Rui;ZHOU Xu-hui(Department of Orthopaedics,Changzheng Hospital,Naval Medical University(Second Military Medical University),Shanghai 200003,China;Department of Orthopaedics,Special Medical Center of PLA Rocket Force,Beijing 100088,China)

机构地区：[1]海军军医大学(第二军医大学)长征医院骨科,上海200003 [2]火箭军特色医学中心骨科,北京100088

出　　处：《第二军医大学学报》2020年第3期248-253,共6页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81772305);上海市教育委员会晨光计划(14CG37).

摘　　要：目的评估成人脊柱侧凸患者长时间步行前后整体和局部的矢状面影像学参数。方法回顾性纳入2016年1月至2018年6月于海军军医大学(第二军医大学)长征医院就诊的98例成人脊柱侧凸患者,根据行走前矢状面参数将患者分为两组:代偿组(行走前矢状面平衡,矢状面躯干偏移<40 mm且骨盆倾斜角>20°)和失代偿组(行走前矢状面失平衡,矢状面躯干偏移≥40 mm且骨盆倾斜角>20°)。步行15 min前后拍摄站立位全脊柱正侧位X线片,测量脊柱矢状面参数,包括矢状面躯干偏移、胸椎后凸角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角。比较两组步行15 min前后脊柱矢状面参数,并对每组步行15 min前后矢状面躯干偏移变化值与其余矢状面参数变化值进行相关性分析。结果代偿组19例,其中女16例、男3例,平均年龄为(64.1±5.9)岁,BMI为(24.2±4.6)kg/m^2;失代偿组79例,其中女67例、男12例,平均年龄为(66.7±7.2)岁,BMI为(24.9±5.1)kg/m^2,两组患者性别构成比、年龄、BMI差异均无统计学意义(P均>0.05)。步行前,代偿组患者腰椎前凸角大于失代偿组(Z=2.784,P=0.003),骨盆入射角-腰椎前凸角和矢状面躯干偏移均小于失代偿组(Z=1.953,P=0.028;Z=3.815,P<0.01);两组间骨盆倾斜角、骶骨倾斜角、胸椎后凸角差异均无统计学意义(P均>0.05)。步行15 min后,两组间骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、骨盆入射角-腰椎前凸角、矢状面躯干偏移差异均无统计学意义(P均>0.05)。与步行前比较,代偿组和失代偿组患者步行15 min后骶骨倾斜角、骨盆入射角-腰椎前凸角、矢状面躯干偏移均增大(代偿组Z=1.718、P=0.043,Z=2.198、P=0.015,Z=3.875、P<0.01;失代偿组Z=1.842、P=0.031,Z=1.943、P=0.021,Z=2.917、P=0.002),骨盆倾斜角和腰椎前凸角均减小(代偿组Z=1.639、P=0.047,Z=3.624、P<0.01;失代偿组Z=1.812、P=0.039,Z=3.893、P<0.01);失代偿组患者步�Objective To assess whole and regional spinal sagittal radiographic parameters before and after a long walk in adult scoliosis patients.Methods A total of 98 adult scoliosis patients,who were admitted to Changzheng Hospital of Naval Medical University(Second Military Medical University)from Jan.2016 to Jun.2018,were retrospectively included.According to sagittal radiographic parameters before a long walk,the patients were assigned to two groups:compensated group(sagittal balance before walking,with sagittal vertical axis[SVA]<40 mm and pelvic tilt[PT]>20°)and decompensated group(sagittal imbalance before walking,with SVA≥40 mm and PT>20°).The anteroposterior and lateral radiographs of whole spine were taken before and after a 15-min walk,and the sagittal radiographic parameters were measured,including SVA,thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),PT and sacral slope(SS).The sagittal radiographic parameters were compared between the two groups before and after a 15-min walk.The correlations between the differences of SVA and other sagittal parameters before and after a 15-min walk were analyzed in two groups.Results There were 19 patients in the compensated group,including 16 females and 3 males,with an average age of(64.1±5.9)years and a body mass index(BMI)of(24.2±4.6)kg/m^2.There were 79 patients in the decompensated group,including 67 females and 12 males,with an average age of(66.7±7.2)years and a BMI of(24.9±5.1)kg/m^2.There were no significant differences in age,gender or BMI between the two groups(all P>0.05).Before walking,the LL was significantly larger in the compensated group than that in the decompensated group(Z=2.784,P=0.003),and the PI-LL and SVA were significantly smaller in the compensated group than those in the decompensated group(Z=1.953,P=0.028;Z=3.815,P<0.01).There were no significant differences in PT,SS or TK between the two groups(all P>0.05).After a 15-min walk,there were no significant differences in PT,SS,LL,TK,PI-LL or SVA between the two groups(all P>0.05

关 键 词：成人脊柱侧凸 矢状面参数 矢状面失衡 影像学评估 步行 

分 类 号：R682.3[医药卫生—骨科学]