腰椎退变性侧后凸冠状位及矢状位脊柱骨盆参数相关性的影像学分析

Radiological analysis of coronal and sagittal spinopelvic parameters in patients with degenerative lumbar kyphoscoliosis

目的 探讨腰椎退变性后凸（DLK）及腰椎退变性侧后凸（DLKS）冠状位与矢状位畸形的相互关系及矢状位平衡的代偿机制.方法 对北京大学人民医院脊柱外科2016年1月至2017年5月收治的82例腰椎退变性畸形患者的影像学资料进行分析研究.82例患者中,男性30例,女性52例;年龄48～82岁,平均年龄66岁.根据是否存在冠状位畸形,将患者分为两组：同时存在腰椎冠状位和矢状位畸形者为DLKS组;仅存在腰椎矢状位畸形者为DLK组.其中,DLKS组患者39例,男性12例,女性27例,年龄51～82岁,平均年龄69岁;DLK组患者43例,男性17例,女性26例,年龄48～79岁,平均年龄64岁.所有患者均拍摄脊柱全长正侧位X线片,分析比较两组患者冠状位与矢状位的脊柱骨盆参数.结果 DLKS组冠状位Cobb角和腰椎前凸角分别为（23.0±11.8）°和（18.2±12.1）°,DLK组腰椎前凸角为（20.4±10.2）°.腰椎退变性侧后凸组冠状位与矢状位参数间,Cobb角与腰椎前凸角（r=-0.338,P=0.035）、冠状位偏移距离与胸腰交界区角（r=0.488,P=0.002）有一定相关性,其他参数间无明显相关性.两组间所有的脊柱骨盆矢状位参数相比较,差异均无统计学意义（P〉0.05）.DLKS组中,腰椎前凸角与胸椎后凸角（r=-0.363,P=0.023）以及骶骨倾斜角（r=0.617,P=0.000）均有相关性.DLK组中,腰椎前凸角与胸椎后凸角（r=-0.341,P=0.025）以及骶骨倾斜角（r=0.772,P=0.000）也有一定相关性.按照Nash-Moe分级对于椎体旋转程度进行评估,DLKS组39例患者中,10例患者为Ⅰ～Ⅱ度,29例患者为Ⅲ～Ⅴ度.结论 腰椎侧凸与后凸之间存在一定的相关性,但DLKS患者冠状位侧凸程度未能影响脊柱矢状位形态;胸椎曲度改变和骨盆后倾均参与了腰椎退变性侧后凸患者矢状位平衡的调节.

Objective To review and compare radiological parameters between degenerative lumbar kyphoscoliosis （DLKS） and degenerative lumbar kyphosis （DLK）, and analyze the relationships between coronal and sagittal deformities and compensatory mechanisms of sagittal balance. Methods A total of 82 patients with lumbar degenerative deformities were enrolled for our radiographic study at Department of Spinal Surgery, Peking University People′s Hospital from January 2016 to May 2017. These patients were divided into two groups：DLKS group （39 patients） with lumbar coronal and sagittal deformities, and DLK group （ 43 patients） just with lumbar sagittal deformity. Complete spinopelvic radiographic parameters were compared. Results The Cobb angle and lumbar lordosis of DLKS group were （23. 0±11. 8）° and （18. 2± 12. 1）°, while the lumbar lordosis of DLK group was （20. 4±10. 2）°. In DLKS group, Cobb angle had correlations with lumbar lordosis （ r=-0. 338, P=0. 035 ） , and central sacral vertical line distance had significant correlations with thoracolumbar junctional angle （ r = 0. 488, P = 0. 002 ） . Moreover, no significant differences of all sagittal spinopelvic parameters were found between two groups （ P〉0. 05） . In DLKS group, significant correlations between lumbar lordosis and sacral slope （ r=0. 617,P=0. 000） , and correlations between lumbar lordosis and thoracic kyphosis（ r=-0. 363,P=0. 023） were observed. In DLK group, lumbar lordosis showed significant correlations with thoracic kyphosis（r=-0. 341,P=0. 025） and sacral slope （r=0.772,P=0.000）. According to Nash-Moe grading scale of apical vertebral rotation, 10 patients were with Ⅰ-Ⅱ grade while 29 patients withⅢ-Ⅴgrade in DLKS group. Conclusions Both as typical lumbar degenerative deformities, there are some correlations between scoliosis and kyphosis. However, coronal scoliosis may not influent sagittal morphological parameters for DLKS patients. Thoracic curve changes and pelvic backtilt are both important for maintaining the sagittal balance in patients with degenerative lumbar kyphoscoliosis.