陈旧性胸腰椎骨折伴后凸畸形的脊柱-骨盆矢状位参数的特征分析  

Analysis of spinopelvic parameters features in post-traumatic thoracolumbar kyphosis

作　　者：郑国辉 于海洋[1] 翟云雷[1] 王伟[1] 刘彬 盛明 Zheng Guohui;Yu Haiyang;Zhai Yunlei;Wang Wei;Liu Bin;Sheng Ming(Department of Orthopedics,Fuyang People's Hospital,Fuyang Clinical College,Anhui Medical University,Fuyang 236000,China)

机构地区：[1]安徽医科大学阜阳临床学院阜阳市人民医院骨科,阜阳236000

出　　处：《骨科临床与研究杂志》2020年第4期220-225,共6页Journal Of Clinical Orthopedics And Research

基　　金：安徽省科技厅重点研究与开发计划项目(1704a0802159)。

摘　　要：目的探究陈旧性胸腰椎骨折伴后凸畸形(PTK)患者脊柱-骨盆参数特征及其对矢状位平衡的影响。方法回顾分析2016年1月至2019年12月在安徽省阜阳市人民医院骨科诊治的82例PTK患者术前影像学资料。其中男29例,女53例,年龄53~76(63.7±5.6)岁,所有患者均行站立位脊柱全长正、侧位X线片检查。利用影像归档与通信系统对所有患者的脊柱-骨盆矢状位参数进行测量,包括局部后凸角(LKCA)、胸椎后凸角(TK)、腰椎前凸角(LL)、上腰弯前凸角(UALL)、下腰弯前凸角(LALL)、骨盆入射角(PI)、骨盆投射角(PT)、骶骨倾斜角(SS)、矢状面平衡(SVA)。无症状人群脊柱-骨盆矢状位参数由文献中获得。统计分析其参数之间的差异及PTK患者脊柱-骨盆参数之间的相关性。结果PTK患者LKCA为46.4°±14.8°,TK为38.9°±15.2°,LL为37.9°±15.1°,UALL为-1.7°±13.9°,LALL为40.2°±12.0°,PI为50.9°±11.7°,PT为25.3°±11.1°,SS为25.4°±12.9°,SVA为(57.1±41.8)mm。TK、LALL、PI、PT、SVA显著高于无症状人群(P<0.05),LL、UALL、SS显著低于无症状人群(P<0.05);LL与PI、PT、SS、TK、SVA相关(r=0.351,-0.401,0.764,0.477,-0.285;P<0.05),SVA与PI、PT、LL相关(r=0.278,0.308,-0.285;P<0.05),LALL与PI、SS呈显著相关(r=0.451,0.488;P<0.05),UALL与PT、SS、TK呈显著相关(r=-0.417,0.466,0.388;P<0.05)。结论PTK患者在TK、LL、PI、PT、SS、SVA等参数上与无症状人群有显著差异,矢状位脊柱与骨盆参数间存在显著相关性;局部后凸的产生使骨盆自身的解剖参数变化,同时骨盆因失平衡发生后倾进行代偿;手术治疗需合理规划重建腰椎前凸,以恢复局部后凸的正常序列为主。Objective To investigate the effect of post-traumatic thoracolumbar kyphosis on spinopelvic parameters and the pattern of pelvic compensation.Methods Preoperative imaging data of 82 patiens(including 29 males and 53 females)with kyphosis attribute to thoracolumbar fracture,treated in the Department of Orthopeadics,Fuyang People's Hospital in Anhui Province from January 2016 to December 2019,were retrospective analyzed,whole spinal X-ray in lateral staning position was performed in all patients.Spinopelvic parameters were measured in all patients including local kyphosis cobb angle(LKCA),thoracic kyphosis(TK),lumbar lordosis(LL),upper arc of total lumbar lordosis(UALL),lower arc of total lumbar lordosis(LALL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal vertical axis(SVA).Spino-pelvic parameters in normal asymptomatic population were obtained from the literature.Differences between parameters in different groups and correlation between spinopelvic parameters in patients with post-traumatic thoracolumbar kyphosis were analyzed.Results There was no significant difference in age between PTK patients and asymptomatic people[(63.7±5.6)y vs(62.4±5.2)y,P>0.05],radiograhic measurements:LKCA,TK,LL,UALL,LALL,PI,PT,SS,SVA were 46.4°±14.8°,38.9°±15.2°,37.9°±15.1°,-1.7°±13.9°,40.2°±12.0°,50.9°±11.7°,25.3°±11.1°,25.4°±12.9°and(57.1±41.8)mm respectively.TK,LALL,PI,PT,SVA were significantly higher than parameters of normal asymptomatic people(P<0.05),LL,UALL and SS were significantly lower than those of normal asymptomatic people(P<0.05),LL was correlated with PI,PT,SS,TK,SVA(r=0.351,-0.401,0.764,0.477,-0.285;P<0.05),SVA was correlated with PI,PT,LL(r=0.278,0.308,-0.285;P<0.05),LALL was significantly correlated with PI,SS(r=0.451,0.488;P<0.05),and UALL was significantly correlated with PT,SS,TK(r=-0.417,0.466,0.388;P<0.05).Conclusions Patients with post-traumatic thoracolumbar kyphosis have significant differences in TK,LL,PI,PT,SS,SVA and other parameters with normal asymptomatic peop

关 键 词：脊柱后凸 脊柱前凸 脊柱骨折 矢状位参数 

分 类 号：R68[医药卫生—骨科学]