中老年人群脊柱-骨盆矢状位参数及其序列拟合关系

Spino-pelvic sagittal parameters in middle-aged and elderly Chinese: measurements and correlationship

目的 ：测量我国中老年人群的脊柱-骨盆矢状位参数并分析其相关性,建立腰椎前凸角与相关脊柱-骨盆矢状位参数的拟合关系。方法：采用影像学测量方法,对106例中老年志愿者进行研究,其中男48例,女58例;年龄62.4±5.2岁（55~76岁）。所有志愿者行全脊柱正、侧位X线摄片,利用院内影像归档与通信系统（picture archiving and communication system,PACS）测量骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）、腰椎前凸角（lumber lordosis,LL）、上腰弯前凸角（upper arc of total lumbar lordosis,UALL）、下腰弯前凸角（lower arc of total lumbar lordosis,LALL）、胸椎后凸角（thoracic kyphosis,TK）、矢状位平衡（sagittal vertical axis,SVA）等参数,按照脊柱矢状面解剖定义和形态特点分析脊柱-骨盆矢状位形态参数及其相关性,并与青年人群相关参数进行比较,利用线性回归分析建立中老年人群LL与PI、TK的拟合关系。结果 ：我国中老年人群的PI为46.5°±7.6°,PT为13.1°±6.6°,SS为32.3°±9.5°,LL为49.2°±9.1°,UALL为15.9°±5.9°,LALL为32.3°±9.5°,TK为34.0°±10.7°,SVA为-5.0±30mm;LL与SS、TK、PI、PT、SVA呈显著性相关（P〈0.05）,PT与TK、SS呈显著性相关（P〈0.05）,UALL与TK、SVA相关,LALL与PI相关。中老年人群与青年人群比较PI、SS、LL、LALL无显著性差异（P〉0.05）,PT、TK、SVA、UALL有显著性差异（P〈0.01）。中老年人群LL预测值=0.6PI＋0.4TK＋10°,R2=0.375。结论：中老年人群中LL与其他相关脊柱-骨盆各参数之间存在显著相关性,我国中老年人群LL的理想预测值为LL=0.6PI＋0.4TK＋10°;TK、UALL、PT、SVA与青年人群有显著性差异。

Objectives： To analyze the spino-pelvic sagittal parameters and their correlationship in middleaged and elderly Chinese, and to establish a prediction between lumber lordosis and the other parameters.Methods： This study was a radiological analysis. Anteroposterior and lateral radiographs of the whole spine were taken in 106 Chinese volunteers, including 48 males and 58 females, aged from 55 to 76 years（average62.4±5.2 years）. Pelvic and spinal parameters including pelvic incidence（PI）, pelvic tilt（PT）, sacral slope（SS）,lumbar lordosis（LL）, thoracic kyphosis（TK）, sagittal vertical axis（SVA）, upper arc of total lumbar lordosis（UALL）, lower arc of total lumbar lordosis（LALL） were measured by using picture archiving and communica-tion systems. The correlations of all parameters were analyzed, and which were compared to the parameters in younger volunteers. A multifactor regression analysis was conducted by using the lumbar lordosis（dependent variable） and the other spino-pelvic parameters（independent variables） to determine the best sets of predictors.Results： Radiograhic measurements： PI, PT, SS, LL, UALL, LALL, TK, SVA were 46.5°±7.6°, 13.1°±6.6°,32.3°±9.5°, 49.2°±9.1°, 15.9°±5.9°, 32.3°±9.5°, 34.0°±10.7° and-5.0±30mm respectively. LL was significantly correlated with PI, SS, TK and SVA（P〈0.05）, PT was significantly correlated with TK and SS. Compared with young people, PI, SS, LL and LALL had no significant difference（P〉0.05）, however, PT, TK, SVA and UALL had significant differences（P〈0.01）. Based on a multifactor regression analysis, LL predictive equation was LL=0.6PI＋0.4TK＋10°, R2=0.375. Conclusions： The spino-pelvic sagittal parameters have a clear correlation in middle-aged and elderly Chinese. There exists obvious difference in the spine and pelvis sagittal parameters such as TK, UALL, PT, SVA between the old and the young. By using the formula LL=0.6PI＋0.4TK＋10°, LL of the middle-aged and elderly can be ideally predicted.