T1骨盆角与退变性脊柱侧凸患者脊柱-骨盆矢状面平衡以及生活质量的相关性分析

Correlations between T1 pelvic angle and spino-pelvic sagittal alignment and health related life quality in patients with degenerative scoliosis

目的：探讨T1骨盆角（T1 pelvic angle,TPA）能否反映退变性脊柱侧凸（degenerative scoliosis,DS）患者脊柱-骨盆矢状面的整体及局部平衡,及其与DS患者生活质量的关系。方法：回顾性分析2007年2月-2011年12月在我院接受手术治疗的DS患者资料。纳入标准：（1）随访时间超过2年;（2）有完整临床及影像学资料。排除标准：（1）既往接受过脊柱手术;（2）同时伴有髋、膝关节病变影响正常的站立姿势。共76例DS患者纳入研究,男9例,女67例,年龄45-72岁,平均58.2±6.1岁。Cobb角32°-74°,平均42.6°±6.1°。顶椎位于L2椎体3例,L2/3椎间盘4例,L3椎体26例,L3/4椎间盘23例,L4椎体16例,L4/5椎间盘4例。随访2.1-6.4年,平均3.7年。术前及末次随访时均摄自然站立位全脊柱正、侧位X线片,同时填写ODI、VAS及SRS-22量表。测量胸椎后凸角（thoracic kyphosis,TK）、胸腰段后凸角（thoracolumbar kyphosis,TLK）、腰椎前凸角（lumbar lordosis,LL）、骨盆入射角（pelvic incidence,PI）、骶骨倾斜角（sacral slope,SS）、骨盆倾斜角（pelvic tilt,PT）、矢状面平衡（sagittal vertical axis,SVA）和TPA。采用Spearman检验分别对术前、末次随访时的SVA和TPA与其他术前、末次随访时的脊柱-骨盆参数作相关性分析,同时分析SVA和TPA术前、末次随访时的变化值与其他脊柱-骨盆参数术前、末次随访时的变化值的相关性。分析SVA和TPA术前、末次随访时的变化值与ODI、VAS及SRS-22总分术前、末次随访时的变化值的相关性。结果：术前TPA与术前LL、SS、PT、PI及SVA显著相关（P〈0.05）,与术前TK、TLK无相关性（P〉0.05）;末次随访时TPA均与末次随访时的LL、SS、PT、PI及SVA显著相关（P〈0.05）,与末次随访时TK、TLK无相关性（P〉0.05）;TPA术前、末次随访时的变化值与LL、SS、PT、PI及SVA术前、末次随访时的变化值显著相关（P〈0.05）,与TK、TLK的变化值无相关性（P〉0.05）;TPA术前、末次随访时的变化值与ODI评分、VAS评分术前、末次随访时的变化值正相关（P〈0.05）,与SRS-22总分变化值负相关（P〈0.05）。术前SVA与术前LL、TPA显著相关（P〈0.05）,与术前TK、TLK、SS、PT、PI无相关性（P〉0.05）;末次随访时SVA与末次随访时TPA显著相关（P〈0.05）,与末次随访时TK、TLK、SS、PT、PI、LL无相关性（P〉0.05）;SVA术前、末次随访时的变化值与LL、TPA术前、末次随访时的变化值显著相关（P〈0.05）,与TK、TLK、SS、PT术前、末次随访时的变化值无相关性（P〉0.05）;SVA术前、末次随访时的变化值与ODI评分、VAS评分术前、末次随访时的变化值正相关（P〈0.05）,与SRS-22总分变化值负相关（P〈0.05）。结论：TPA整合了整体和局部脊柱-骨盆矢状面平衡的信息,能够反映DS患者脊柱-骨盆矢状面的整体及局部平衡,且与DS患者的生活质量密切相关,对于DS重建手术有着重要的指导意义。

Objectives： To investigate whether T1 pelvic angle（TPA） can represent sagittal balance, and to investigate the relationship between TPA and health related quality of life（HRQOL） of patients with degenerative scoliosis（DS）. Methods： Patients with DS who received surgery from February 2007 to December 2011 were retrospectively reviewed. Inclusion criteria were as followings： having follow-ups longer than 2 years and the complete radiographic and clinical data. Patients were excluded when they had received spinal surgery or suffered from hip or knee disease. A total of 76 DS patients（male： 9; female： 67） was included with an average age of 58.2±6.1 years（range： 45-72 years） and an average Cobb angle of 42.6°±6.1°（range： 32°-74°）. Four patients had apical vertebrae at L2, 4 at L2/3 disc, 26 at L3, 23 at L3/4 disc, 16 at L4 and 4 at L4/5 disc.The sagittal alignment parameters were measured on both preoperative and last follow-up radiographs, including thoracic kyphosis（TK）, thoracolumbar kyphosis（TLK）, lumbar lordosis（LL）, pelvic incidence（PI）, sacral slope（SS）, pelvic tilt（PT）, sagittal vertical axis（SVA） and TPA. Oswestry disability index（ODI）, visual analog scale（VAS） and SRS-22 questionnaire were completed by the patients before surgery and at the last follow-up.Spearman′s rank correlation coefficient was used to determine correlations between preoperative and last follow-up SVA and other spino-pelvic parameters, and so as TPA. Correlations between the changes of TPA and the changes of other parameters and overall ODI scores, VAS and SRS-22 total scores were also analyzed. Results： Preoperative and last follow-up TPAs were significantly related to the preoperative and last follow-up LL, PT, SS, PI, and SVA（P〈0.05）, but not to TK and TLK（P〉0.05）. The changes of TPA were significantly related to the changes of LL, PT, SS and SVA（P〈0.05）, but not to TK and TLK（P〈0.05）. Moreover,the changes of TPA were also significantly related to the changes of ODI（P〈0.05）, VAS（P〈0.05） and SRS-22 total scores（P〈0.05）. Preoperative SVA was significantly related to the preoperative LL and TPA（P〈0.05）, but not to TK, TLK, SS, PT and PI（P〈0.05）. The last follow-up SVA was significantly related to the last follow-up TPA（P〈0.05）, but not to TK, TLK, LL, SS, PT and PI（P〉0.05）. The changes of SVA were significantly related to the changes of LL and TPA（P〈0.05）, but not to TK, TLK, SS and PT（P〈0.05）. The changes of SVA were also significantly related to the changes of ODI（P〈0.05）, VAS（P〈0.05） and SRS-22 total scores（P〈0.05）.Conclusions： TPA can better reflect spino-pelvic sagittal alignment and HRQOL for patients with degenerative scoliosis. which can be served as a reference parameter in surgical planning.