CAJ | 학술논문

目的描述正常成人的骨盆矢状位形态,分析正常成人脊柱-骨盆矢状位序列类型.方法采用前瞻性影像学分析对139名志愿者进行研究,男94名,女45名；年龄21～28岁,平均(23.5±1.5)岁.所有志愿者行全脊柱正、侧位X线检查,利用院内影像归档与通信系统(picture archiving and communication systems,PACS)测量骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS).按照脊柱矢状面解剖定义和形态特点描述脊柱各矢状面形态参数,分析各参数间相关性,并根据腰椎前凸顶点位置不同分析国人腰椎-骨盆矢状位序列类型.结果 PI平均值为45.1°±9.6°,明显小于西方成人,并明显小于韩国成人；女性PI值明显高于男性.骨盆各参数间密切相关,脊柱相邻前凸节段、后凸节段间密切相关,腰弯前凸还与颈弯前凸、矢状位平衡(sagittal vertical axis,SVA)密切相关；依据腰弯前凸顶点位置,将腰椎-骨盆矢状位序列分为四型:Ⅰ型,顶点位于L5椎体或L4,5椎间隙,共11名(占7.8％)；Ⅱ型,顶点位于L4底部或中部,共61名(占43.3％)；Ⅲ型,顶点位于L4上部或L34椎间隙,共33名(占23.4％)；Ⅳ型,顶点位于L3椎体及其以上,共34名(占24.5％).所有志愿者的胸弯后凸顶点为T6.7,颈弯胸弯拐点为C7.各类型间骨盆矢状位形态、腰弯倾斜程度存在明显差异.结论中国正常成人骨盆矢状位形态与西方和韩国人群存在明显差异.腰椎通过骨盆的调节后,在维持脊柱整体矢状位平衡方面起到核心作用；随着腰弯前凸顶点提高,脊柱-骨盆序列将出现骶骨增加倾斜、下腰弯前凸角度增加、下腰弯组成椎体数量增加、腰弯倾斜减小等变化.
목적 묘술정상성인적골분시상위형태,분석정상성인척주-골분시상위서렬류형.방법 채용전첨성영상학분석대139명지원자진행연구,남94명,녀45명；년령21～28세,평균(23.5±1.5)세.소유지원자행전척주정、측위X선검사,이용원내영상귀당여통신계통(picture archiving and communication systems,PACS)측량골분입사각(pelvic incidence,PI)、골분경사각(pelvic tilt,PT)、저골경사각(sacral slope,SS).안조척주시상면해부정의화형태특점묘술척주각시상면형태삼수,분석각삼수간상관성,병근거요추전철정점위치불동분석국인요추-골분시상위서렬류형.결과 PI평균치위45.1°±9.6°,명현소우서방성인,병명현소우한국성인；녀성PI치명현고우남성.골분각삼수간밀절상관,척주상린전철절단、후철절단간밀절상관,요만전철환여경만전철、시상위평형(sagittal vertical axis,SVA)밀절상관；의거요만전철정점위치,장요추-골분시상위서렬분위사형:Ⅰ형,정점위우L5추체혹L4,5추간극,공11명(점7.8％)；Ⅱ형,정점위우L4저부혹중부,공61명(점43.3％)；Ⅲ형,정점위우L4상부혹L34추간극,공33명(점23.4％)；Ⅳ형,정점위우L3추체급기이상,공34명(점24.5％).소유지원자적흉만후철정점위T6.7,경만흉만괴점위C7.각류형간골분시상위형태、요만경사정도존재명현차이.결론 중국정상성인골분시상위형태여서방화한국인군존재명현차이.요추통과골분적조절후,재유지척주정체시상위평형방면기도핵심작용；수착요만전철정점제고,척주-골분서렬장출현저골증가경사、하요만전철각도증가、하요만조성추체수량증가、요만경사감소등변화.
Objective To describe sagittal pelvic pattern,and to analyze sagittal spino-pelvic alignment in asymptomatic Chinese adults.Methods This was a prospective radiological analysis.Anteroposterior and lateral radiographs of the whole spine were taken in 139 Chinese volunteers,including 94 males and 45 females,aged from 21 to 28 years (average,23.5±1.5 years).By using picture archiving and communication systems,several pelvic and spinal parameters (pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,cervical lordosis,sagittal vertical axis,apex of total lumbar lordosis,total lumbar lordosis,upper arc of total lumbar lordosis,lower arc of total lumbar lordosis,junctional level,apex of total thoracic kyphosis,total thoracic kyphosis,total cervical lordosis,and lordosis tilt) were measured and the correlations of all parameters were analyzed.Results The mean value of pelvic incidence was 45.1°±9.6°,which was significantly less than those reported in western and Korean subjects.Total lumbar lordosis has a significant correlation with pelvic incidence,sacral slope,total thoracic kyphosis,cervical lordosis and sagittal vertical axis.The sagittal lumbar-pelvic alignment was classified into 4 types according to position of apex of total lumbar lordosis:type Ⅰ (11 cases),the apex was located in L5 or intervertebral space between L4 and L5; type Ⅱ (61 cases),the apex was located in bottom or middle of L4; type Ⅲ (33 cases),the apex was located in upper part of L4 or in intervertebral space between L3 and L4; type Ⅳ (34 cases),the apex was located at L3 level or more high level.Conclusions The sagittal pelvic pattern of Chinese adults is significantly different from those of western and Korean.Lumbar lordosis plays a critical role in regulating spinal sagittal balance.With upper shift of apex of total lumbar lordosis,the lower lumbar lordosis angle and sacral slope increase,but the lordosis tilt decreases.