退变性腰椎滑脱患者坐-立位脊柱-骨盆矢状面序列的影像变化  

Imaging changes in spinal-pelvic sagittal alignment in sitting and standing positions in degenerative lumbar spondylolisthesis patients

作　　者：刘阳 徐宝山[1] 许海委[1] 黎宁[1] 姜洪丰[1] 王涛[1] 刘越[1] Liu Yang;Xu Baoshan;Xu Haiwei;Li Ning;Jiang Hongfeng;Wang Tao;Liu Yue(Department of Minimally Invasive Spine Surgery,Tianjin Hospital,Tianjin 300211,China)

机构地区：[1]天津市天津医院微创脊柱外科,天津市300211

出　　处：《中国组织工程研究》2020年第24期3857-3861,共5页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(31670983),项目负责人:徐宝山;国家自然科学基金资助项目(31500781),项目负责人:许海委。

摘　　要：背景:脊柱-骨盆矢状面序列对于退变性腰椎滑脱的诊治十分重要,但是目前关于退变性腰椎滑脱患者脊柱-骨盆矢状面序列的研究局限在站立位体位,坐位下的脊柱-骨盆矢状面序列未见相关报道。目的:分析退变性腰椎滑脱患者坐-立位脊柱-骨盆矢状位序列的影像学资料,探究退变性腰椎滑脱患者脊柱-骨盆矢状位序列从站立位到坐位的变化特点。方法:纳入2019年3至9月天津市天津医院收治的44例退变性腰椎滑脱患者,其中男12例,女32例,年龄50-84岁,所有患者均拍摄站立位全脊柱X射线片和坐位全脊柱X射线片,通过院内影像归档与通信系统测量每例患者的骨盆入射角、骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、矢状面平衡轴等参数,比较退变性腰椎滑脱患者站立位、坐位矢状位序列的不同,运用Pearson相关分析探讨站立位、坐位脊柱-骨盆矢状位参数间相关性。试验获得天津市天津医院伦理委员会批准。结果与结论:①由站立位转变为坐位时,44例退变性腰椎滑脱患者的骨盆倾斜角增大[(21.3±10.1)°,(34.0±10.4)°,P<0.001]、骶骨倾斜角减小[(31.5±8.6)°,(20.8±12.7)°,P<0.001]、腰椎前凸角减小[(40.9±14.6)°,(25.8±15.0)°,P<0.001]、矢状面平衡轴增大[(43.0±43.4),(75.0±34.8)mm,P<0.001],骨盆入射角与胸椎后凸角无明显改变(P>0.05);②无论站位还是坐位,腰椎前凸角与其他5项参数均具有相关性(P<0.05);由站位转换为坐位后,骶骨倾斜角与矢状位平衡参数矢状面平衡轴的相关性消失(P>0.05),腰椎前凸角与矢状面平衡轴的相关性仍然存在(P<0.05);③结果表明退变性腰椎滑脱患者从站位转换为坐位时,脊柱-骨盆矢状位形态表现为骨盆围绕双侧股骨头发生后旋,骨盆呈后倾状态,腰椎生理曲度变浅,脊柱矢状位平衡轴前移。BACKGROUND:Spinal-pelvic sagittal alignment is important for the diagnosis and treatment of degenerative lumbar spondylolisthesis.However,the current study of the spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis is limited to the standing position.There is no relevant report on the spine-pelvic sagittal alignment under the sitting position.OBJECTIVE:To analyze imaging data of sitting-standing spine-pelvic sagittal alignment in patients with degenerative lumbar spondylolisthesis,and to determine the sagittal alignment of spine change in degenerative lumbar spondylolisthesis patients from standing position to sitting position.METHODS:Totally 44 patients with degenerative lumbar spondylolisthesis(12 males,32 females;age,50-84 years)were enrolled from Tianjin Hospital from March to September 2019.All patients took X-rays of the spine in standing and sitting positions.Through the hospital image archiving and communication system,spinal and pelvic parameters were measured,including pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,and sagittal vertical axis.The parameters were compared between standing posture and sitting posture.By using Pearson’s correlation test,differences of relationship between spinal and pelvic parameters in standing versus sitting position were discussed.This study was approved by the Ethics Committee of Tianjin Hospital.RESULTS AND CONCLUSION:(1)When moving from standing to sitting position,in 44 degenerative lumbar spondylolisthesis patients,pelvic tilt increased[(21.3±10.1)°,(34.0±10.4)°,P<0.001];sacral slope decreased[(31.5±8.6)°,(20.8±12.7)°,P<0.001];lumbar lordosis reduced[(40.9±14.6)°,(25.8±15.0)°,P<0.001];sagittal vertical axis increased[(43.0±43.4),(75.0±34.8)mm,P<0.001];pelvic incidence and thoracic kyphosis did not significantly changed(P>0.05).(2)Whether standing or sitting position,lumbar lordosis was correlated with other parameters(P<0.05).When changing from standing to sitting position,the correlatio

关 键 词：脊柱 骨盆 矢状位序列 体位变化 退变性腰椎滑脱 站位 坐位 腰椎手术 

分 类 号：R445.4[医药卫生—影像医学与核医学] R322.7[医药卫生—诊断学]