成人脊柱-骨盆矢状面分型的初步研究

Preliminary study for classification of spino-pelvic sagittal alignment in adult volunteers

目的探讨以腰椎前凸角（LL）及胸腰椎转折椎间隙（IP）为基础对成人脊柱-骨盆矢状面分型的可行性。方法2011年7月至8月对223名志愿者进行脊柱全长正位X线检查，符合纳入标准的研究对象111名，女性56名，男性55名。测量脊柱-骨盆矢状面参数值，包括胸椎后凸角（TK）、胸腰段后凸角（TLK）、LL、骨盆倾斜角（PT）、骶骨倾斜角（SS）、骨盆指数（PI）、各椎体间终板夹角、脊柱骶骨角（SSA）、矢状面垂轴（SVA）、IP。根据LL、TP将成人脊柱-骨盆矢状面分为3型，Ⅰ型：LL〉-40°，IP为L2-3以下；Ⅱ型：-60°≤LL≤-40°，IP为L11-2或T12～L1；Ⅲ型：LL〈-60°，IP为T11-12以上。采用Pearson相关分析对各变量间的相关性进行分析，Ⅰ～Ⅲ型组间各参数分别进行单因素方差分析及多重比较。结果经测量LL为-49°±10°，TK为36°±7°，TLK为6°±7°，PT为11°±7°，SS为34°±8°，PI为45°±9°，SSA为127°±9°，SVA为（-2．7±22．8）mm。仅LL与其他参数的相关性均有统计学意义，与TK、PI、SS、SSA呈负相关（r=-0．387、-0．536、-0．858、-0．801，P〈0．05），与TLK、SVA、PT呈正相关（r=0．319、0．296、0．262，P〈0．05）。入选志愿者均可纳入分型：Ⅰ型19例，Ⅱ型75例，Ⅲ型17例。各型间LL、TK、TLK、PT、SS、PI、SSA、SVA差异均有统计学意义（F=164．559、7．431、14．099、4．217、53．856、6．252、35．995、8．626，P〈0．05）。进一步多重比较示LL、SS、SSA、PI组间两两比较差异均有统计学意义（P〈0．05）。结论LL是脊柱矢状面平衡的核心参数，以腰椎前凸角及胸腰椎转折椎间隙为基础可将成人脊柱-骨盆矢状面分为3型。该分型系统可较好反映脊柱-骨盆矢状面的形态差异及平衡。

Objective To investigate the feasibility of the classification of the spino-pelvic sagittal alignment in adluts according to lumbar lordosis （LL） and inflection point （IP）. Methods Whole spine, standing radiographs of 223 adult volunteers were taken from July to August in 2011 . There were 111 cases （56 female and 55 male） enrolled in the study based on the inclusion criteria. The pelvic and spinal parameters, including thoracic kyphosis （ TK）, thoracolumbar kyphosis （ TLK）, LL, sacral slope （ SS）, pelvic tilt（PT）, pelvic＇, incidence（PI）, intervertebral endplate angle, sagittal vetlical axis （SVA）, spinosacral angle （SSA） and IP were measured. The spino-pelvic sagittal alignment were classified in to 3 types according toLLand IP. Type Ⅰ ：LL〉 -40°,IP located below L2-3; TypeⅡ： -60°°〈LL°〈 -40°,IP located in L1 -2 or T12 - L1 ; Type Ⅲ ：LL 〈 -60° , IP located above T11 -12. Pearson correlation analysis was used to test the correlation between the variables. The parameters in each type were compared by oneway- ANOVA respectively,then additional multiple comparisons were performed. Results The mean value of LL was -49° ±10°, TK was 36° ±7°, TLK was 6° ±7°, PT was 11° ±7°, SS was 34° ±8°, PI was 45° ± 9°, SSA was 127° ± 9°and SVA was（ -2.7 ± 22.8）mm, respectively. Only LL had significant statistical correlation with all the other parameters. Negative correlation presented between LL and TK, PI, SS, SSA （r ： -0. 387, -0. 536, -0. 858, -0. 801 ,P 〈 0. 05 ）. Positive correlation presented between LL and TLK,SVA, FF （ r = 0.319,0. 296,0. 262, P 〈 0. 05 ）. All the volunteers were c.lassified into the 3 types ： Type 1 19 cases,Type 11 75 eases,Type Ⅲ 17 eases. Oneway-ANOVA resuhs showed statistical difference in LL, TK,TLK,PT,SS,PI,SSA,SVA among the 3 types, （F = 164. 559,7. 431 , 14. 099,4. 217,53. 856,6. 252, 35. 995,8. 626,P 〈 0. 05 ）. Muhiple comparisons showed that LL, SS, SSA, PI had statistical difference between each two types comparison （ P 〈 0. 05 ）. Conclusions EL is tile central parameter of the spinopelvic＇ sagittal balance . The patterns of tile spino-pelvic sagittal alignment in adults could be classified into three types, according to LL and [P. The classification could describe the morphological differenees and balance of the spino-pelvic sagittal aligmnent.