终末期原发髋关节骨关节炎患者脊柱-骨盆矢状面形态异常及其与腰痛关系的初步研究
종말기원발관관절골관절염환자척주-골분시상면형태이상급기여요통관계적초보연구
Preliminary study of spinal-pelvic sagittal alignment and its relationship with lumbar pain in patients with end-stage primary hip osteoarthritis
  • 万方数据
    中华关节外科杂志（电子版） 중화관절외과잡지（전자판）
    CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
    2014年 6期 746-751 ,共6页

    吴明达%王渭君%徐志宏%刘飞%邱勇%翁文杰

    오명체%왕위군%서지굉%류비%구용%옹문걸

    脊柱%矢状面平衡%关节成形术,置换,髋 脊柱%矢狀麵平衡%關節成形術,置換,髖
    척주%시상면평형%관절성형술,치환,관
    Spine%Sagittal balance%Athroplasty,replacement,hip
    目的：探讨终末期原发髋关节骨关节炎（ HOA）患者在脊柱-骨盆矢状面上的形态与伴随的腰痛症状的关系。方法收集46例HOA患者及55例正常对照的立位全脊柱侧位X线片，测量腰椎前凸角（LL）、骶骨倾斜角（SS）、骨盆倾斜角（PT）、骨盆投射角（PI）、脊柱骶骨角（SSA）、脊柱前倾角（ST）；将HOA患者根据是否存在腰痛分为无腰痛组（23例）和有腰痛组（23例），对后者的腰痛进行评分（ VAS）。应用独立样本的t检验比较HOA患者与正常人的各个参数，并采用非参数检验比较HOA亚组间及其与正常对照的差异；将HOA患者的各个参数与VAS评分进行相关性分析。结果原发性HOA组和正常人组的年龄及性别分布无统计学差异，两组的LL分别为（45.2°±17.3°和51.1°±8.5°，t＝－2.627， P＜0.05）； ST分别为（87.8°±8.3°和94.5°±3.0°， t ＝－6.652， P＜0.01），组间差异有统计学意义，两组间的SS、PT、PI及SSA无统计学差异。与正常对照组相比，HOA腰痛组的LL（39.4°±19.47°， t＝－4.260， P＜0.05）、SSA（121.5°±13.5°， t＝－3.287， P＜0.05）和ST（87.6°±8.0°， t＝－6.478， P＜0.05）均明显偏小，差异有统计学意义；而无腰痛组的SS（42.1°±11.1°， t＝3.496， P＜0.05）明显偏大、PT（10.3°±8.8°，t＝－2.466， P＜0.05）及ST（88.1°±8.8°， t＝－5.678， P＜0.05）明显偏小，差异有统计学意义，其他参数间无明显差异。相关性分析显示HOA患者的腰痛VAS评分与LL、SS、PT之间存在明显相关性（ P＜0.05）。结论 HOA患者存在脊柱-骨盆的矢状面形态异常，表现为较正常人腰椎前凸减小、脊柱前倾增加。与正常对照相比，无腰痛HOA患者骨盆及脊柱均前倾，但腰椎前凸无明显减小；有腰痛的HOA患者骨盆无明显前倾，但腰椎前凸减小，脊柱前倾增加。这些结果表明HOA患者的腰痛可能与其腰椎矢状面形态改变存在一定的联系。
    목적：탐토종말기원발관관절골관절염（ HOA）환자재척주-골분시상면상적형태여반수적요통증상적관계。방법수집46례HOA환자급55례정상대조적립위전척주측위X선편，측량요추전철각（LL）、저골경사각（SS）、골분경사각（PT）、골분투사각（PI）、척주저골각（SSA）、척주전경각（ST）；장HOA환자근거시부존재요통분위무요통조（23례）화유요통조（23례），대후자적요통진행평분（ VAS）。응용독립양본적t검험비교HOA환자여정상인적각개삼수，병채용비삼수검험비교HOA아조간급기여정상대조적차이；장HOA환자적각개삼수여VAS평분진행상관성분석。결과원발성HOA조화정상인조적년령급성별분포무통계학차이，량조적LL분별위（45.2°±17.3°화51.1°±8.5°，t＝－2.627， P＜0.05）； ST분별위（87.8°±8.3°화94.5°±3.0°， t ＝－6.652， P＜0.01），조간차이유통계학의의，량조간적SS、PT、PI급SSA무통계학차이。여정상대조조상비，HOA요통조적LL（39.4°±19.47°， t＝－4.260， P＜0.05）、SSA（121.5°±13.5°， t＝－3.287， P＜0.05）화ST（87.6°±8.0°， t＝－6.478， P＜0.05）균명현편소，차이유통계학의의；이무요통조적SS（42.1°±11.1°， t＝3.496， P＜0.05）명현편대、PT（10.3°±8.8°，t＝－2.466， P＜0.05）급ST（88.1°±8.8°， t＝－5.678， P＜0.05）명현편소，차이유통계학의의，기타삼수간무명현차이。상관성분석현시HOA환자적요통VAS평분여LL、SS、PT지간존재명현상관성（ P＜0.05）。결론 HOA환자존재척주-골분적시상면형태이상，표현위교정상인요추전철감소、척주전경증가。여정상대조상비，무요통HOA환자골분급척주균전경，단요추전철무명현감소；유요통적HOA환자골분무명현전경，단요추전철감소，척주전경증가。저사결과표명HOA환자적요통가능여기요추시상면형태개변존재일정적련계。
    Objective To discuss the correlation between the spinal-pelvic sagittal alignment and the lower back pain ( LBP) in the patients with end-stage primary hip osteoarthritis ( HOA) .Methods The up-right standing lateral X-ray films of the spine and pelvis were taken from 46 patients with primary HOA and 55 normal controls.The lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), spinal sacral angle (SSA), and spinal tilt (ST) were measured.The patients with HOA were divided into two subgroups based on LBP ( 23 cases in each subgroup ) , and the LBP was assessed by visual analogue score ( VAS) .The comparison between HOA patients and normal controls were performed by independent-samples t test while the subgroups and the normal-control group were compared by non-parametric t test .The correlations between VAS and the measured parameters were analysed in the patients with HOA.The statistical significance was defined as P <0.05.Results There was no significant difference in neither age or gender distribution between the HOA patients and the normal controls .The HOA patients showed significant lower LL (45.2°±17.3°vs 51.1°±8.5°, t=-4.260, P<0.05) and ST (87.8°±8.3°vs 94.5°±3.0°, P<0.01) but no difference in SS, PI, PI and SSA when compared to the normal controls.The patients with LBP showed significantly smaller LL (39.4°±19.7°, t=-4.260, P<0.05), SSA (121.5°±13.5°, t=-3.287, P<0.05) and ST (87.6°±8.0°, t=-6.478, P<0.05) compared to the normal controls , while the patients without LBP showed significant larger SS ( 42.1°± 11.1°, t=3.496, P<0.05) but smaller PT (10.3°±8.8°, t=-2.466, P<0.05) and ST (88.1°± 8.8°, t=-5.678, P<0.05).In addition, the significant correlations were retrieved between the VAS scores and LL, SS and PT in the patients with HOA (P<0.05).Conclusions Abnormal spinal-pelvic sagittal alignment was found in the patients with HOA , presenting with decreased lumbar lordosis but increased forward inclination of the spine .However, the HOA patients without LBP presented forwardly inclined pelvis and spine but normal lumbar lordosis , while those with LBP presented normal pelvic inclination but increased spinal forward inclination and smaller lumbar lordosis , when compared to the normal controls .This study suggests that the abnormalities in the sagittal alignment of lumbar spine and spinal-pelvis might contribute to the LBP in the patients with HOA .
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