青少年特发性脊柱侧凸Lenke1 B、C型患者的胸椎后凸状态对腰骶椎矢状面形态的影响

The effect of thoracic kyphosis on sagittal balance of the lumbosacral spine in Lenke 1 B/C adolescent idiopathicscoliosis patients

[目的]探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)Lenke1B、C患者的胸椎矢状面形态(thoracic kyphsis,TK)对腰骶椎矢状面形态的影响及意义。[方法]86例Lenke1B、C患者(男37例、女49例;平均年龄14.2岁)被纳入本研究,所有患者均摄站立位全脊柱正侧位X线片。根据胸椎后凸(TK)分为两组:A型TK<10°和B型10°≤TK≤40°。统计、测量以下影像学参数:腰椎前凸(LL)、上腰椎前凸、下腰椎前凸、主胸弯Cobb角、矢状面平衡(SVA)、骨盆投射角(PI)、骶骨倾斜角(SS)和骨盆倾斜角(PT)。[结果]A型的LL和上腰椎前凸小于B型的LL和上腰椎前凸(P<0.01)。相关性结果显示TK与LL(r=0.68,P=0.02)、上腰椎前凸(r=0.89,P=0.003)存在线性相关。此外,PT、SS及PI之间也存在线性相关。[结论]AIS Lenke1B、C患者的胸椎矢状面形态对腰椎前凸有明显影响,并通过上腰椎对整个腰椎形态产生影响。因此,对此类型患者在进行选择性胸椎融合时必须考虑这种相互影响,避免术后发生远端失代偿。

CHEN Tao;JIA Shi-qing;LIU Chang-sheng;The Department of Spinal Surgery,Orthopedic Hospital; [Objective] To investigate the effect of thoracic kyphosis（ TK） on sagittal balance of lumbosacral vertebrae in Lenke 1B / C AIS patients. [Methods] Standing lateral radiographs of entire spine were obtained in all subjects（ male 37,female 49; mean age 14. 2 years）. According to thoracic kyphosis,patients were divided into 2 groups,namely,group A（ thoracic kyphosis 10°） and group B（ 10°≤thoracic kyphosis≤40°）. The following parameters were measured： lumbar lordosis（ LL）,upper and lower arc of lumbar lordosis,main thoracic cobb angle,sagittal imbalance（ SVA）,pelvic incidence（ PI）,sacral slope（ SS） and pelvic tilting（ PT）. [Results] Compared with Group B,Group A demonstrated smaller LL and upper arc of lumbar lordosis（ P〈0. 01）. Correlation analysis showed that TK was significantly associated with LL（ r = 0. 68,P =0. 02） and upper arc of lumbar lordosis（ r = 0. 89,P = 0. 003）,as well as PT,SS and PI. [Conclusion] Sagittal balance of lumbosacral vertebrae in Lenke 1B / C patients was influenced by TK through the adaptation of upper arc of lumbar lordosis. Therefore,this effect must be considered in Lenke 1B / C patients undergoing selective posterior thoracic fusion,avoiding the occurrence of distal adding- on.