退行性脊柱侧凸患者冠状面和矢状面影像学参数分析

Coronal and sagittal radiographic parameters in degenerative scoliosis

目的：分析退行性脊柱侧凸（DS）患者的影像学特征，探讨与DS患者冠状面影像学参数与矢状面平衡之间的关系。方法：回顾性分析99例DS患者的人口统计学资料和影像学资料，包括年龄、性别、冠状位Cobb角、顶椎椎体/椎间盘的位置、侧凸的方向、顶椎旋转度、侧凸节段、胸椎后凸角（TK）、腰椎前凸角（LL）、胸腰椎后凸角（TL）、骶骨角（SS）、骨盆倾斜角（PT）、骨盆入射角（PI）、矢状位垂直轴（SVA）和PI-LL。根据矢状面平衡情况将患者分为两组：失平衡组（A组），SVA＞5cm；平衡组（B组），SVA≤5cm，比较两组患者的人口学和影像学参数。结果：99例患者中女83例，男16例；年龄41～92岁（中位数为67岁）；冠状位Cobb角10°～75°（中位数为23°）；侧凸长度3～7个椎体（中位数为5个椎体）。顶椎最常见的位置在L2/3（81%），顶椎椎体旋转程度的中位数为Ⅱ度（Ⅰ~Ⅲ度）。冠状位Cobb角和侧凸节段相关（r=0.23，P＜0.005），和顶椎旋转亦相关（r=0.53，P＜0.005）。A组33例，B组66例；两组间年龄、LL、PT、冠状位Cobb角、顶椎旋转度和PI-LL均有显著性差异（P＜0.05），两组间性别、TK、TL、SS和PI无显著性差异（P〉0.05）。结论：DS患者冠状位Cobb角与侧凸节段和顶椎旋转间有相关关系；矢状位平衡和失衡患者的年龄、冠状位Cobb角、LL、PT和PI-LL均不同。

Objectives： To analyze the radiographic characteristics in degenerative scoliosis（DS）, and to explore the radiograghic parameters which correlated to sagittal balance. Methods： Medical records of 99 DS patients were reviewed. Demographic data included age and sex. Radiographic data including the coronal Cobb angle, location of apical vertebra/disc, convexity of curve, degree of apical vertebra rotation, curve segments, thoracic kyphosis（TK）, lumbar lordosis（LL）, thoracolumbar kyphosis（TL）, sacral slope（SS）, pelvic tilt（PT）, pelvic incidence（PI）, sagittal vertical axis（SVA） and PI minus LL（PI-LL） were reviewed. Furthermore, patients were divided into 2 groups according to whether the patients′ sagittal plane was balanced or not： imbalanced group（group A） with SVA〉5 cm, and balanced group（group B） with SVA≤5 cm. Demographic and radiological parameters were compared between the 2 groups. Results： A total of 99 patients were included in this study, including 83 females and 16 males. The age ranged from 41 to 92 years, and the mean age was 67 years. The median of coronal Cobb angle and length of curve were 23°（range, 10°-75°） and 5 segments（range, 3-7）, respectively. The most common location of apical vertebra was at L2 to L3（81%） and the mean degree of apical vertebra rotation was Ⅱ°（range, Ⅰ°-Ⅲ°）. The study also showed significant correlations between coronal Cobb angle and curve segments（r=0.23, P〈0.005）, coronal Cobb angle and degree of apical vertebra rotation（r=0.53, P〈0.005）. With regard to the sagittal balance, there were significant differences in age, LL, PT, coronal Cobb angle, degree of apical vertebra rotation and PI-LL between group A（33 patients） and group B（66 patients）（P〈0.05）; however, no significant difference was observed in gender, TK, TL, SS or PI（P〉0.05）. Conclusions： Coronal Cobb angle is significant correlated to curve segments and degree of apical vertebra rotation in DS patients. Furthermore, age, coronal Cobb angle, LL, PT and PILL between sagittal balance and imbalance are significantly different.