高低位腰椎椎间盘突出症患者脊柱-骨盆矢状面形态变化  

Spinopelvic sagttal morphological changes in patients with high and low level lumbar disc herniation

作　　者：芦银江 余春华 许汉荣 陈启明 朱仰义 Lu Yinjiang;Yu Chunhua;Xu Hanrong;Chen Qiming;Zhu Yangyi(Department of Spinal Surgery,Shangyu People's Hospital of Shaoxing,Shaoxing 312300,Zhejiang,China)

机构地区：[1]绍兴市上虞人民医院脊柱外科,绍兴312300

出　　处：《脊柱外科杂志》2024年第1期27-31,共5页Journal of Spinal Surgery

摘　　要：目的 比较高位与低位腰椎椎间盘突出症(LDH)患者脊柱-骨盆矢状面形态学差异,探讨脊柱-骨盆矢状面形态学参数异常与高位LDH发生的关系。方法 纳入2006年1月—2022年1月收治的高位LDH患者53例(高位组),同时期性别、年龄和体质量指数(MBI)匹配的低位LDH患者53例(低位组)及单纯下腰部疼痛的非LDH患者53例(对照组)。在站立位全脊柱侧位X线片上测量3组矢状面平衡(SVA)、胸椎后凸角(TK)、腰椎前凸角(LL)、腰骶前凸角(LSL)、骶骨倾斜角(ST)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)等脊柱-骨盆矢状面参数。结果 高位组SVA、TK明显高于对照组,LL、ST、PI、PT及SS明显低于对照组;高位组TK明显高于低位组,LL、ST及PI明显低于低位组;差异均有统计学意义(P <0.05)。高位组L1/L2节段患者的LL、ST较L2/L3节段患者有下降趋势,但差异无统计学意义(P> 0.05)。结论 骨盆水平化导致的胸腰段过度代偿可能是高位LDH发生、发展的机制之一。Objective To compare the difference of spinopelvic sagttal morphology between patients with high and low level lumbar disc herniation(LDH),and investigate the relationship between the abnormal spinal sagittal morphological parameters and high level LDH.Methods From January 2006 to January 2022,53 patients with high level LDH(high level group),53 patients with low level LDH(low level group)and 53 simple low back pain patients without LDH(control group)matched by gender,age and body mass index(BMI)were selected.The sagital parameters were measured on standard standing full spine roentgenographs,including sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),lumbosacral lordosis(LSL),sacral tilt(ST),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS).Results SVA and TK in the high level group were significantly higher than those in the control group,while LL,ST,PI,PT and SS were significantly lower than those in the control group;TK in the high level group was significantly higher than that in the low level group,while LL,ST and PI were significantly lower than those in the low level group;the differences were statistically significant(P<0.05).LL and ST in L/L,LDH group were lower than those in Lo/Ls LDH group,but there was no statistically significant difference(P>0.05).Conclusion The overcompensation of the thoracolumbar segment caused by pelvic flattening may be one of the mechanisms underlying the occurrence and progression of high level LDH.

关 键 词：腰椎 椎间盘移位 肌肉骨骼平衡 摄影测量法 

分 类 号：R681.533[医药卫生—骨科学]