腰椎间盘退变与脊柱-骨盆矢状面平衡的相关性
요추간반퇴변여척주-골분시상면평형적상관성
Correlation of lumbar disc degeneration and spinal-pelvic sagittal balance
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2013年 15期 1123-1128 ,共6页

    刘辉%希腊本大%郑召民%王建儒%杨豪%李泽民%王太平%王华%乌扎布

    류휘%희석본대%정소민%왕건유%양호%리택민%왕태평%왕화%오찰포

    椎间盘%平衡%腰椎%脊柱-骨盆矢状面平衡参数 椎間盤%平衡%腰椎%脊柱-骨盆矢狀麵平衡參數
    추간반%평형%요추%척주-골분시상면평형삼수
    Intervertebral disc%Equilibrium%Lumbar vertebrae%Spino-pelvic sagittal balance parameters
    目的 探讨各节段腰椎间盘退变与矢状面平衡各参数之间的关系.方法 回顾性分析2009年7月至2012年6月腰椎退行性疾病患者随访资料共126例,其中摄有脊柱全长正侧位片者38例,仅摄有腰椎正侧位者88例,所有病例均摄有腰椎MRI片.采用Image J软件测量以下脊柱-骨盆矢状面参数:(1)脊柱参数:矢状面躯干偏移(SVA)、胸椎后凸角(TK)、胸腰后凸角(TLK)、腰椎前凸角(LL)；(2)骨盆参数:骨盆投射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)；(3)脊柱-骨盆整体参数:T1脊柱骨盆倾斜角(T1-SPI)、T9脊柱骨盆倾斜角(T9-SPI)、脊柱-骶骨角(SSA)、脊柱-骨盆角(SPA)、C7倾斜角(C7T).根据椎间盘Pfirrmann分级系统,将各节段椎间盘退变等级分级记录.以矢状面平衡各参数的测量数值与常模的大小关系及椎间盘退变等级为依据进行分组,比较各节段椎间盘退变等级与矢状面平衡参数间的关系.结果 PI对L5/S1椎间盘退变程度具有显著影响.L5/S1退变程度对矢状面平衡影响显著.大PI组57例中,L5/S1椎间盘轻-中度和重度退变组LL为(36.9±14.9)和(29.7±11.3),差异有统计学意义(P=0.045)；PT为(18.8±8.3)和(25.2±10.2),差异有统计学意义(P =0.012)；SS为(39.5±8.8)和(34.6±8.9),差异有统计学意义(P =0.042)；SVA为(23.0±26.6)和(62.2±33.8),差异有统计学意义(P=0.002)；C7T为(88.9±3.1)和(84.0±4.6),差异有统计学意义(P=0.003)；SPA为(157.9±11.2)和(147.8±14.0),差异有统计学意义(P =0.043).L1/2椎间盘轻-中度和重度退变组TLK为(4.6±7.8)和(14.9±14.8),差异有统计学意义(P=0.026).L1/2,L2/3,L3/4退变程度对SPA有显著影响.L1/2两组SPA为(158.5±12.0)和(147.8±12.7),差异有统计学意义(P =0.031)；L2/3两组SPA为(159.9±10.8)和(148.8±13.2),差异有统计学意义(P=0.024)；L3/4两组SPA为(158.5±10.9)和(148.6±13.9),差异有统计学意义(P =0.047).结论 骨盆解剖学参数的改变PI对腰椎间盘退变程度有重要影响；L5/S1椎间盘退变程度对骨盆姿势性参数(PT、SS)有显著影响,L5/S1的退变是引起骨盆后旋机制参与代偿过程的重要因素；L5/Sl椎间盘退变对脊柱-骨盆整体参数(SVA、SPA、C7T)有重要影响,L5/S1的退变是引起躯干失衡的重要因素.
    목적 탐토각절단요추간반퇴변여시상면평형각삼수지간적관계.방법 회고성분석2009년7월지2012년6월요추퇴행성질병환자수방자료공126례,기중섭유척주전장정측위편자38례,부섭유요추정측위자88례,소유병례균섭유요추MRI편.채용Image J연건측량이하척주-골분시상면삼수:(1)척주삼수:시상면구간편이(SVA)、흉추후철각(TK)、흉요후철각(TLK)、요추전철각(LL)；(2)골분삼수:골분투사각(PI)、골분경사각(PT)、저골경사각(SS)；(3)척주-골분정체삼수:T1척주골분경사각(T1-SPI)、T9척주골분경사각(T9-SPI)、척주-저골각(SSA)、척주-골분각(SPA)、C7경사각(C7T).근거추간반Pfirrmann분급계통,장각절단추간반퇴변등급분급기록.이시상면평형각삼수적측량수치여상모적대소관계급추간반퇴변등급위의거진행분조,비교각절단추간반퇴변등급여시상면평형삼수간적관계.결과 PI대L5/S1추간반퇴변정도구유현저영향.L5/S1퇴변정도대시상면평형영향현저.대PI조57례중,L5/S1추간반경-중도화중도퇴변조LL위(36.9±14.9)화(29.7±11.3),차이유통계학의의(P=0.045)；PT위(18.8±8.3)화(25.2±10.2),차이유통계학의의(P =0.012)；SS위(39.5±8.8)화(34.6±8.9),차이유통계학의의(P =0.042)；SVA위(23.0±26.6)화(62.2±33.8),차이유통계학의의(P=0.002)；C7T위(88.9±3.1)화(84.0±4.6),차이유통계학의의(P=0.003)；SPA위(157.9±11.2)화(147.8±14.0),차이유통계학의의(P =0.043).L1/2추간반경-중도화중도퇴변조TLK위(4.6±7.8)화(14.9±14.8),차이유통계학의의(P=0.026).L1/2,L2/3,L3/4퇴변정도대SPA유현저영향.L1/2량조SPA위(158.5±12.0)화(147.8±12.7),차이유통계학의의(P =0.031)；L2/3량조SPA위(159.9±10.8)화(148.8±13.2),차이유통계학의의(P=0.024)；L3/4량조SPA위(158.5±10.9)화(148.6±13.9),차이유통계학의의(P =0.047).결론 골분해부학삼수적개변PI대요추간반퇴변정도유중요영향；L5/S1추간반퇴변정도대골분자세성삼수(PT、SS)유현저영향,L5/S1적퇴변시인기골분후선궤제삼여대상과정적중요인소；L5/Sl추간반퇴변대척주-골분정체삼수(SVA、SPA、C7T)유중요영향,L5/S1적퇴변시인기구간실형적중요인소.
    Objective To elucidate the relationship between spino-pelvic sagittal balance parameters and lumbar intervertebral disc degeneration of each segment through retrospective analysis in lumbar degeneration patients.Methods Retrospective analysis was conducted for the follow-up data in 126 patients with lumbar degenerative disease from July 2009 to June 2012.There were 38 cases with whole spine plates and 88 cases with lumbar plates.All of them received magnetic resonance imaging (MRI)scans.Through software Image J,the following spino-pelvic sagittal balance parameters were measured:sagittal vertical axis (SVA,distance between C7 plumb line and posterior upper corner of S1 endplate),thoracic kyphosis (TK,T5-T12 Cobb angle),thoracolumbar kyphosis (TLK,T10-L2 Cobb angle),lumbar lordosis (LL,L1-L5 Cobb angle),pelvic incidence (PI),pelvic tilt (PT),sacral slope (SS),T1 spinopelvic inclination (T1-SPI),T9 spino-pelvic inclination (T9-SPI),spino-sacral angle (SSA),spino-pelvic angle (SPA) and C7 tilt (C7T).Based on the grading system of Pfirrmann et al,the intervertebral disc degeneration grades were acquired for each lumbar segment.According to the normal range of previous studies,each spino-pelvic sagittal balance parameter was classified into 3 groups,i.e.Group A (less than normal),Group B (normal) and Group C (more than normal).All statistical analyses were performed to compare the differences of each lumbar segment/intervertebral disc degeneration among groups by one-way ANOVA test via SPSS 18.0.And P-value ＜ 0.05 was deemed significant.Results PI had a significant impact on the L5/S1 disc degeneration.And L5/S1 disc degeneration had a significant impact on sagittal balance.Among 57 cases of large PI,LL,PT,SS,SVA,C7T,SPA in L5/S1 of mild-to-moderate and severe degeneration groups was 36.91 ± 14.93 and 29.71 ± 11.30 (P =0.045),18.82 ± 8.27 and 25.18±10.19 (P=0.012),39.45±8.82and34.57±8.88 (P=0.042),23.04±26.63 and 62.15± 33.82 (P =0.002),88.85 ±3.13 and 83.98 ±4.62 (P =0.003),157.88 ± 11.20 and 147.75 ± 13.98 (P =0.043) respectively.TLK in L1/L2 with mild-to-moderate and severe degeneration groups was 4.59 ± 7.81 and 14.91 ± 14.75 (P =0.026).All of L1/L2,L2/L3 and L3/L4 disc degeneration had a significant impact on SPA.SPA in L1/L2,L2/L3,and L3/L4 with mild-to-moderate and severe degeneration groups was 158.47 ± 11.97 and 147.84 ± 12.72 (P=0.031),159.91 ± 10.78 and 148.75 ± 13.17 (P =0.024),158.46±10.86 and 148.61 ±13.93 (P=0.047) respectively.Conclusion With an important impact on lumbar disc degeneration,PI,either too big or too small,may predispose to the occurrences of lumbar disc degeneration.LS/S1 disc degeneration has a significant impact on pelvis postural parameters (PT,SS).L5/S1 degeneration is a key causative factor of pelvic posterior rotation and compensatory process.LS/S1 disc degeneration has an important impact on pelvis overall parameters (SVA,SPA,C7T).And the degeneration of L5/S1 is a key cause of trunk imbalance.
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