退变性胸腰椎后凸与陈旧性胸腰椎骨折后凸矢状面代偿模式的比较

Comparison of sagittal compensatory mechanism between degenerative and post-traumatic kyphosis in thoracolumbar spine

目的：比较退变性胸腰椎后凸（DTK）与陈旧性胸腰椎骨折后凸（PTK）患者矢状面代偿模式的差异.方法：回顾性分析2010年6月～2015年2月在我科门诊或在院接受诊疗的32例DTK患者和28例PTK患者的一般资料,并纳入30例健康成人作为对照组.90例研究对象中男性42例,女性48例,平均年龄47.2岁（30～70岁）,DTK组、PTK组和对照组年龄分别为56.0±7.3岁、39.0±8.5岁和45.5±5.5岁.所有研究对象均拍摄立位全脊柱正、侧位X线片.分别测量三组研究对象脊柱矢状位后凸角（KA）、胸椎后凸角（TK）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）及矢状位平衡（SVA）,比较三组之间以上脊柱骨盆参数的差异.结果：（1） DTK组和对照组的TK明显大于PTK组（分别为26.5°±5.8°、26.0°±6.3°和23.3°±7.8°,P＜0.05）,而DTK组与对照组比较无显著性差异（P＞0.05）;（2）DTK组的LL、SS（分别为23.1°±12.4°、20.4°±7.7°）均明显小于PTK组（分别为43.4°±7.8°、30.4°±6.6°）和对照组（分别为42.1°±8.5°、31.1°±5.5°）（P＜0.001）,而PTK组的LL、SS与对照组比较无显著性差异（P＞0.05）;DTK组的SVA、PT（分别为62.7±17.5mm、26.1°±11.9°）均明显大于PTK组（分别为16.7±7.1 mm、16.7°±8 6°）和对照组（分别为15.8±7.4mm、15.4°±6.6°）（P＜0.001）,而PTK组与对照组的SVA、PT比较无显著性差异（P＞0.05）;（3）DTK组与PTK组的KA（分别为46.7°±12.8°、46.0°±13.8°）无显著性差异（P＞0.05）;DTK组、PTK组和对照组的PI（分别为45.5°±9.7°、46.1°±8.8°、45.1°±8.8°）无显著性差异（P＞0.05）.结论：退变性胸腰椎后凸患者表现为腰椎前凸减小,骨盆后旋转,并最终出现躯干前倾的矢状面失代偿;陈旧性胸腰椎骨折后凸患者仅表现为TK减小、以骨折椎体为中心的局部后凸,而未发生整体脊柱骨盆参数的代偿.

Objectives：To compare the sagittal compensatory mode between degenerative thoracolumbar kyphosis（DTK） and post-traumatic thoracolumbar kyphosis（PTK）.Methods：Retrospective analysis was conducted on 60 patients with thoracolumbar kyphosis treated in our hospital from June 2010 to February 2015 （32 DTK and 28 PTK）.For comparison,30 asymptomatic volunteers were included as control group.The average age of DTK,PTK and control group was 56.0±7.3,39.0±8.5,45.5±5.5 years old,respectively.Standing long cassette posteroanterior and lateral X-ray films were taken for each patient.Kyphosis angle （KA）,thoracic kyphosis（TK）,lumbar lordosis（LL）,pelvic incidence（PI）,pelvic tilt（PT）,sacral slope（SS） and sagittal vertical axis （SVA） were measured.Differences in these spino-pelvic parameters were compared among the three groups.Results：（1）The TK of DTK group and control group was significantly higher than that of PTK group （26.5°±5.8°,26.0°±6.3° and 23.3°±7.8°,respectively）（P＜0.05）,but no difference was found between DTK group and control group（P＞0.05）.（2）The LL and SS were significantly lower in DTK group（23.1°±12.4°,20.4°±7.7°） than those in PTK group（43.4°±7.8°,30.4°±6.6°） and control group（42.1°±8.5°,31.1°±5.5°）（P＜0.001）.But there were no significant differences between PTK group and control group （/P＞0.05）.Additionally,DTK group had higher SVA and PT（62.7±17.5mm,26.1°±11.9°） than PTK group（16.7±7.1mm,16.7°±8.6°） and control group （15.8±7.4mm,15.4°±6.6°）（P＜0.001）,but the values of SVA and PT were similar in PTK group and control group（P＞0.05）.（3）There was no significant difference in KA between DTK group and PTK group（46.7°±12.8° vs 46.0°±13.8°）; no significant difference was found in PI among the three groups （45.5°±9.7°,46.1°±8.8°,45.1°±8.8°,P＞0.05）.Conclusions：Patients with DTK tend to present sagittal decompensation with decreased LL,retroversion of the pelvis and anterior-shifted SVA.However,regional kyphosis and decreased TK are the common sagittal profile in PTK patients with balanced spino-pelvic alignment.