椎体和椎间盘矢状面形态学改变对退变性脊柱后凸畸形的影响  

Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity

作　　者：何守玉 李海东 闵继康 罗盛昌 戴季林 HE Shou-yu;LI Hai-dong;MIN Ji-kang;LUO Sheng-chang;DAI Ji-lin(Spine Surgery,the First Affiliated Hospital ofHuzhou Teachers College,Huzhou 313000,Zhejiang,China)

机构地区：[1]湖州师范学院附属第一医院脊柱外科,浙江湖州313000

出　　处：《中国骨伤》2023年第7期653-657,共5页China Journal of Orthopaedics and Traumatology

基　　金：浙江省医药卫生科技计划项目(编号:2020KY941)。

摘　　要：目的:探讨椎体楔形变和椎间盘退变(塌陷)等形态学改变对成人退变性胸腰椎/腰椎后凸畸形的影响。方法:回顾性分析2015年8月至2020年12月收治的32例脊柱退变性胸腰椎/腰椎后凸畸形患者,其中男8例,女24例,年龄48~75(60.3±12.4)岁。在站立位全脊柱正侧位X线片上测量脊柱冠状面侧凸Cobb角和矢状面胸腰椎/腰椎后凸角(kyphosis angle,KA),评估顶椎(apex vertebral,AV)及顶椎上下各2个椎体(AV-1,AV-2,AV+1,AV+2)与椎间盘(AV-1D,AV-2D,AV+1D,AV+2D)的高度及楔变参数,包括椎体前缘高度(anterior vertebral body height,AVH),椎体后缘高度(posterior vertebral body height,PVH),椎体楔变角(vertebral wedge angle,VWA),椎体楔变率(ratio of vertebral wedging,RVW);椎间盘前缘高度(anterior disc height,ADH),椎间盘后缘高度(posterior disc height,PDH),椎间盘楔变角(disc wedge angle,DWA),椎间盘楔变率(ratio of disc wedging,RDW),椎间盘贡献率(DWA/KA)。结果:所纳入患者KA为(44.2±19.1)°,后凸节段内椎体前缘高度均显著低于椎体后缘高度(P<0.05),提示椎体发生不同程度楔形变;而后凸节段内椎间盘前后缘高度差异无统计学意义。后凸节段内椎体楔变率/贡献率分别为AV-2(14.98±10.95)%/(14.21±8.08)%,AV-1(21.08±12.39)%/(18.09±7.38)%,AV(26.94±11.94)%/(25.52±8.64)%,AV+1(24.19±8.42)%/(20.82±8.69)%,AV+2(20.56±7.80)%/(15.60±9.71)%,椎体总贡献率为(94.23±22.25)%;后凸节段内椎间盘楔变率/贡献率分别为AV-2D(2.88±2.57)%/(5.27±4.11)%,AV-1D(1.98±1.41)%/(2.29±2.16)%,AV+1D(-5.54±3.75)%/(-0.57±0.46)%,AV+2D(-8.27±4.62)%/(-1.22±1.11)%,椎间盘总贡献率(5.77±4.79)%,且顶椎贡献率明显大于邻近椎体贡献率(P<0.05)。结论:椎体楔形变及椎间盘塌陷共同构成了成人退变性胸腰椎/腰椎后凸畸形状态。就对后凸贡献率而言,椎体形态改变对后凸的贡献要远超椎间盘的贡献,且顶椎的楔形变对胸腰椎/腰椎后凸的贡献尤为明显。Objective To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration(collapse)on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK)deformity.Methods A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020,including 8 males and 24 females,aged 48 to 75(60.3±12.4)years old.On the long-cassette standing upright lateral radiographs,the coronal Cobb angle,sagittal thoracic lumbar/lumbar kyphosis angle(KA)of spine were measured,and the height and wedge parameters of apex vertebral(AV)and two vertebrae(AV-1,AV-2,AV+1,AV+2)above and below AV and the intervertebrae and the intervertebral disc(AV-1D,AV-2D,AV+1D,AV+2D)were evaluated,involving anterior vertebral body height(AVH),posterior vertebral body height(PVH),vertebral wedge angle(VWA),ratio of vertebral wedging(RVW),anterior disc height(ADH),posterior disc height(PDH),disc wedge angle(DWA),ratio of disc wedging(RDW),and DWA/KA.Results The average angle of kyphosis was(44.2±19.1)°.A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005).There was no significant difference in anterior and posterior height of discs.The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%,AV-1(21.08±12.39)%/(18.09±7.38)%,AV(26.94±11.94)%/(25.52±8.64)%,AV+1(24.19±8.42)%/(20.82±8.69)%,AV+2(20.56±7.80)%/(15.60±9.71)%,total contribution(94.23±22.25)%,the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%,AV-1D(1.98±1.41)%/(2.29±2.16)%,AV+1D(-5.54±3.75)%/(-0.57±0.46)%,AV+2D(-8.27±4.62)%/(-1.22±1.11)%,total contribution(5.77±4.79)%.And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).Conclusion The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis.However,the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc.The c

关 键 词：退变性后凸畸形 胸腰椎 腰椎 椎体楔形变 椎间盘退变 

分 类 号：R682[医药卫生—骨科学]