骨性结构参数的不对称变化在腰椎侧凸角度进展中的意义

Significance of asymmetry variation of bony construction parameters in the progress of lumbar scoliosis angle

目的探讨骨性结构参数的不对称变化在腰椎侧凸角度进展中的意义。方法回顾性分析2006年4月至2012年4月,就诊于我院门诊及住院治疗的56例诊断为退变性腰椎侧凸患者的影像学资料。侧凸角度>30°的32例患者为轻度侧凸组,侧凸角度<30°的24例患者为重度侧凸组,测量并比较两组患者的骨性结构参数:凸凹侧平均椎间高度、平均椎体高度、平均关节突矢状角、顶椎旋转度。采用多元线性回归分析侧凸角度与骨性结构参数变化的相关性。结果所有病例凸凹侧骨性结构参数之间均存在着差异,平均椎间盘高度及平均椎体高度凸侧高于凹侧,平均关节角度凸侧大于凹侧。重度侧凸组的椎间不对称度、椎体不对称度、关节角不对称度、顶椎旋转度及侧凸角度均大于轻度侧凸组,差异有统计学意义(t椎间=12.1,t椎体=10.7,t关节=4.6,t顶锥=9.3,t侧凸角=5.9;P<0.05)。多元线性回归分析得出,轻度侧凸组的回归方程:Cobb's角=11.041+1.186椎间不对称度-0.372椎体不对称度+0.128关节角不对称度,重度侧凸组的回归方程:Cobb's角=14.525+0.736椎间不对称度+4.016椎体不对称度+1.331关节角不对称度+0.442顶椎旋转度。结论退变性腰椎侧凸的凸凹侧之间骨性结构参数存在着差异,且不对称度随着侧凸角度的增加而增大。当侧凸角度<30°时,侧凸角度主要受到椎间盘不对称退变的影响;侧凸角度>30°时,侧凸角度主要受到椎体不对称退变的影响。

Objective To investigate the significance of asymmetry variation of bony construction parameters in the progress of lumbar scoliosis angle. Methods The imaging data of 56 patient diagnosed as degenerative lumbar scoliosis in the clinic and being hospitalized in our hospital from April 2006 to April 2012 were retrospectively analyzed. 32 patients with the Cobb’s angle of less than 30° were selected as light scoliosis group, and 24 patients with the Cobb’s angle of more than 30° were selected as severe scoliosis group. The bony construction parameters were measured and compared between the 2 groups, including the mean intervertebral height between the concave side and the convex side, the mean vertebral height, the mean sagittal angle of the articular process and the apical vertebral rotation. The correlation between the Cobb’s angle and the changes of bony construction parameters were analyzed by using the multiple linear regression. Results There were significant differences in the bony construction parameters between the concave side and the convex side in all patients. The mean disc height and vertebral height were higher in the convex side than that in the concave side, and the mean articular angle was larger in the convex side than that in the concave side. The asymmetry degrees of intervertebral height, vertebral height and articular angle, apical vertebral rotation and Cobb’s angle in the severe scoliosis group were larger than that in the light scoliosis group, and the differences were statistically significant （t=12.1 [intervertebral height], t=10.7 [vertebral height], t=4.6 [articular angle], t=9.3 [apical vertebral rotation], t=5.9 [Cobb’s angle]; P〈0.05）. The multiple linear regression analysis showed the equation in the light scoliosis group was the Cobb’s angle=11.041＋1.186 asymmetry degree of intervertebral height-0.372 asymmetry degree of vertebral height＋0.128 asymmetry degree of articular angle, and the equation in the severe scoliosis group was the Cobb’s angle=14.525＋0.736 asymmetry degree of intervertebral height＋4.016 asymmetry degree of vertebral height＋1.331 asymmetry degree of articular angle＋0.442 apical vertebral rotation. Conclusions Differences in the bony construction parameters between the concave side and the convex side exist in the patients with degenerative lumbar scoliosis, and the asymmetry degree becomes larger with the increasing of the Cobb’s angle. When the Cobb’s angle is less than 30°, disc asymmetrical degeneration is the main factor influencing the scoliosis angle. When the Cobb’s angle is more than 30°, vertebral asymmetrical degeneration is the main factor.