青少年腰椎间盘突出症患者脊柱-骨盆矢状面形态的影像学研究

Sagittal spino-pelvic alignment in adolescent patients with lumbar disc herniation

目的：评估青少年腰椎间盘突m症（adolescent lumbar disc herniation，ALDH）患者的矢状面脊柱一骨盆彤念，并探讨其与正常青少年间是否存在差异。方法：2006年3月～2012年5月收治ALDH患者30例，其中男18例．女12例．年龄12～18岁，平均16．0±3．1岁。年龄及性别叽配的正常青少年40例作为对照组，其中男24例．女16例，年龄13～18岁，平均16．6±2．1岁。在站立位全脊柱侧位X线片上测量胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（1umbar lordosis，LL）、矢状面平衡（sagittal vertical axis，SVA）、骨盆投射角（pelvicincidence，PI）、骨盆倾斜角（pelvictilt，lYF）和骶骨倾斜角（sacralslope，SS），并对两组间的上述影像学指标进行比较分析。结果：两组年龄及性别比无统汁学差异（P〉0．05）。ALDH组矢状而TK（9．1°±7．0°）、LL（22．5°±12．2°）和SS（20．2°±6．2°）均显著小于正常对照组（分别为24．8°±8．2°、47．8°±9．5°、32．5°±6．7°）（P〈0．05）；ALDH组矢状面Prr（21．5°±613°）、SVA（一5．O±31．2mm）大于正常对照组（8．9°±7．3°、一18．7±18．6mm）（P〈0．05）；ALDH组PI为41．2°±8．5°，对照组PI为42．2°±7．1°，两组问比较无统计学筹异（P〉0．05）。结论：ALDH患者Ⅳ值与正常青少年相近。与正常青少年相比，ALDH患者表现出明显的骶骨垂直化、胸椎及腰椎生理曲度减小，这种矢状面异常町能是患者为了缓解疼痛而采取的一种保护性体位所致。

Objectives： To evaluate the sagittal spino-pelvic alignment in adolescent lumbar disc herniation （ALDH） patients compared with normal adolescents. Methods： From March 2006 to May 2012, a total of 30 patients with AI,DH, including 18 males and 12 females with the age ranging from 12 to 18 years（averaged 16.0±3.1 years） was reviewed retrospectively. Forty adolescents（24 males and 16 females） with the age ranging from 13 to 18 years（averaged 16.6±2.1 years） were selected as the normal controls. On standing lateral X-ray, the following parameters were measured： thoracic kyphosis（TK）, lumbar lordosis（LL）, sagittal vertical axis（SVA）, pelvic incidence（PI）, pelvic tilt（PT） and sacral slope（SS）. Sagittai spino-pelvic parameters were analyzed and compared between two groups. Results： No significant difference was found between two groups in terms of age and gender ratio（P〉0.05）. The average TK（9.1°±7.0°）, LL（22.5°±12.2°） and SS（20.2°±6.2°） was smaller in ALDH group than normal, controls（TK, 24.8°±8.2°; LL, 47.8°±9.5°; SS, 32.5°±6.7°） respectively（P〈0.05）. How- ever, the average PT（21.5°±6.3°） and SVA（-5.0±31.2mm） was higher in ALDH group than normal controls（PT, 8.9°±7.3°; SVA, -18.7±18.6mm）（P〈0.05）. There was no significant difference between two groups with respect to PI （41.2°±8.5° in ALDH group, 42.2°±7.1° in controls）（P〉0.05）. Conclusions： PI is similar between two groups. The sagittal features, including vertical sacrum, thoracic hypokyphosis and straight lumbar spine might be related to a protective posture for pain relief in ALDH patients.