基于Lee分型的正常成年国人脊柱-骨盆矢状位形态的改良分型  

Improved classification of normal Chinese adult sagittal spino-pelvic alignment based on the Lee classification system

作　　者：宋通渠 张建伟 周婷婷[2] 李晶晶 马超[1] 刘光普[1] Song Tongqu;Zhang Jianwei;Zhou Tingting;Li Jingjing;Ma Chao;Liu Guangpu(Department of Spine Surgery,Xuzhou Central Hospital,Xuzhou 221009,China;Department of Endocrinology,Xuzhou First People's Hospital,Xuzhou 221002,China)

机构地区：[1]徐州市中心医院脊柱外科,徐州221009 [2]徐州市第一人民医院内分泌科,徐州221002

出　　处：《中华解剖与临床杂志》2024年第6期384-390,共7页Chinese Journal of Anatomy and Clinics

基　　金：江苏省卫生健康委科研项目(Z2022040);江苏省徐州市医学重点人才培养项目(XWRCHT20220050);中国博士后项目(314233)。

摘　　要：目的探讨正常成年国人脊柱-骨盆矢状位X线影像学形态特征,以及基于Lee分型的脊柱-骨盆矢状位序列改良分型系统的建立及其临床意义。方法前瞻性描述性研究。招募2020年5月—2023年5月徐州市中心医院体检中心140名健康成年国人志愿者,收集其标准站立位脊柱全长正侧位X线片,其中男59例、女81例,年龄18~49(32.9±10.4)岁。(1)利用图像存储与传输系统对胸椎后凸角(TK)、腰椎前凸角(LL)、腰椎水平线(HLL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)和骨盆入射角(PI)等参数进行X线影像测量;(2)采用Pearson相关检验和Spearman秩相关检验进行各参数间相关性分析;(3)基于Lee分型系统,根据HLL的具体位置制定脊柱-骨盆矢状位序列改良分型系统,对比分析不同的改良分型间上述参数测量值的差异;(4)对比改良分型与Roussouly分型的读片时间(s)。结果(1)本组140名志愿者各参数X线测量值如下:TK为25.7°±8.6°,LL为48.4°±10.8°,SS为35.0°±8.1°,PT为9.7°±7.1°,PI为44.7°±10.3°。(2)脊柱-骨盆各参数间相关分析结果显示,HLL与PI、LL、PT、SS均呈正相关(r=0.514、0.503、0.211、0.169,P值均<0.05),HLL与TK呈负相关(r=-0.189,P=0.025);PI与SS、LL、PT均呈正相关(r=0.727、0.528、0.622,P值均<0.001);LL与SS、TK呈正相关(r=0.827、0.410,P值均<0.05),与PT呈负相关(r=-0.176,P=0.037);TK与PI、SS、PT以及SS与PT均无相关性(P值均>0.05)。(3)根据HLL的位置建立的脊柱-骨盆矢状位序列改良分型系统共分为4型:Ⅰ型,HLL低于L4/5椎间隙,占3.6%(5/140);Ⅱ型,HLL经过L4椎体及L4/5椎间隙,占39.3%(55/140);Ⅲ型,HLL经过L3椎体及L3/4椎间隙,占45.7%(64/140);Ⅳ型,HLL高于L3上终板,占11.4%(16/140)。PI、SS自Ⅰ型至Ⅳ型逐渐递增,LL自Ⅰ型至Ⅲ型逐渐递增、至Ⅳ型则有下降,PT值在Ⅰ型最高、Ⅱ型最低,TK值则在Ⅰ型最低、Ⅱ型最高。4个分型间PI、SS、LL、PT、TK总体比较,差异均有统计学意义(H=36.99�Objective This study aimed to explore the planning and clinical significance of an improved spino-pelvic sagittal classification system based on the Lee classification system.Methods A prospective descriptive study was conducted.From May 2020 to May 2023,anteroposterior and lateral X-rays of the entire spine were taken in a standing position for 140 healthy adult volunteers(59 males and 81 females)with a mean age of 18-49(32.9±10.4)years.Imaging analysis was performed to assess thoracic kyphosis(TK),lumbar lordosis(LL),horizontal lumbar level(HLL),sacral slope(SS),pelvic tilt(PT),and pelvic incidence angle(PI).Correlation analysis was conducted to evaluate the relationship between each parameter.An improved classification system based on the Lee classification system and HLL was developed.The differences in the measurement values of the aforementioned parameters among subjects with different classifications were analyzed.In addition,we compared the reading time(second)of the Roussouly classification after consistency testing.Results The X-ray measurements of each parameter of 140 healthy adult volunteers in this group were as follows:TK was 25.7°±8.6°,LL was 48.4°±10.8°,SS was 35.0°±8.1°,PT was 9.7°±7.1°,and PI was 44.7°±10.3°.Significant correlations were observed between HLL and TK,LL,SS,PT,and PI(all P values<0.05).The improved classification system based on HLL was divided into four types.Type I corresponds to an HLL lower than the L4/5 intervertebral space,accounting for 3.6%(5/140)of cases.TypeⅡcorresponds to an HLL passing through the L4 vertebral body and the L4/5 intervertebral space,accounting for 39.3%(55/140)of cases.TypeⅢcorresponds to an HLL passing through the L3 intervertebral space and the vertebral body,as well as the L3/4 intervertebral space,accounting for 45.7%(64/140)of cases.TypeⅣcorresponds to an HLL higher than the L3 superior endplate,accounting for 11.4%(16/140)of cases.The PI and SS values gradually increased from typeⅠto typeⅣ,while the LL value gradually inc

关 键 词：脊柱 骨盆 腰椎水平线 放射摄影术 解剖形态学 读片时间 

分 类 号：R816.8[医药卫生—放射医学]