下腰椎椎间盘退变与脊柱-骨盆矢状面平衡参数间的关系

Correlation of Lower Lumbar Disc Degeneration and Spino-pelvic Sagittal Balance Parameters

分析比较下腰椎各节段椎间盘退变程度与脊柱-骨盆矢状面各平衡参数间的关系。选取符合选择标准的130例腰椎退行性疾病患者均拍摄脊柱全长X线片以及腰椎MR,依据Pfirrmann分级评定病变节段椎间盘的退变程度;利用院内影像归档与通信系统(PACS)测量以下矢状面参数:矢状面躯干位移(SVA)、腰椎前凸角(LL)、胸椎后凸角(TK)、骨盆倾斜角(PT)、骨盆入射角(PI)、骶骨倾斜角(SS)。将所有患者按PI测量值分为小于正常范围组(A组)、正常范围组(B组)和大于正常范围组(C组),分节段比较各组椎间盘退变程度;以矢状面平衡各参数的测量数值与椎间盘退变等级为依据进行分组,比较各节段椎间盘退变等级与矢状面平衡参数间的关系。L_5~S_1椎间盘退变对脊柱-骨盆整体参数具有重要影响,是导致躯干失衡的重要因素。大于正常范围的PI可导致或加重L_5~S_1节段椎间盘的退变;PT及PI与下腰椎椎间盘退变程度显著相关。

The purpose of this study was to study the relationship between lumbar intervertebral disc of lower segments degeneration and spino-pelvic sagittal balance parameters.130 patients had taken full length spine X-ray and lumbar MR.The diseased intervertebral disc degeneration grades were classified according to Pfirrmann evaluation system.Based on Picture Archiving and Communication System（PACS）,the following spinopelvic sagittal balance parameters were measured ：sagittal vertical axis（SVA,distance between C7 plumb line and posterior upper corner of S1 endplate）,Lumbar lordosis（LL,L1-L5 Cobb angle）,thoracic kyphosis（TK,T5-T（12） Cobb angle）,pelvic incidence（PI）,pelvic Tilt（PT）,sacral slope（SS）.From PI measurement values,all the patients were divided into 3 groups,i.e.Group A（less than normal）,Group B（normal）and Group C（more than normal）to compare the different lumbar intervertebral disc of segments degeneration grades.Then,the relationship between lumbar intervertebral disc of segments degeneration and spinopelvic sagittal balance parameters was analyzed.L5-S1 lumbar intervertebral disc degeneration has important impact on spinopelvic parameters,which is a key point of trunk imbalance.High PI may lead to or aggravate lumbar intervertebral disc degeneration at L5-S1 segments;PT and PI are significantly associated with the lower lumbar spine disc degenerative levels.