新鲜腰椎骨质疏松性椎体压缩骨折对腰椎脊柱-骨盆矢状位参数和Roussouly分型分布的影响

Effects of fresh lumbar osteoporotic vertebral compression fracture on spinopelvic sagittal parameters and distribution of Roussouly types

目的 探讨新鲜腰椎骨质疏松性椎体压缩骨折（OVCF）对脊柱-骨盆各参数和Roussouly分型分布的影响.方法 回顾性分析2016年1月至2017年8月北京大学首钢医院骨科诊治的腰椎单节段OVCF患者（OVCF组,108例）和单纯骨质疏松症（OP）患者（单纯OP组,110例）资料,统计所有患者临床基本信息,均进行腰椎Roussouly分型.测量并比较两组患者的骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）等脊柱-骨盆矢状位参数和Roussouly分型分布,观察OVCF组患者骨折节段与Roussouly分型分布的相关性.结果 OVCF组和单纯OP组的PI（50.35°±11.00°和51.96°±11.73°）差异无统计学意义（P＞0.05）,而OVCF组的PT（18.79°±9.51°）大于单纯OP组（16.19°±9.03°）,SS（31.56°±7.88°）、LL（40.22°± 12.29°）小于单纯OP组（35.77°±8.82°、47.89°±13.20°）,差异均有统计学意义（P＜0.05）.OVCF组的Roussouly分型Ⅰ～Ⅳ型的例数分别为35例、40例、28例、5例,其中Ⅰ、Ⅱ型占69.5％;单纯OP组中,Ⅰ～Ⅳ型的例数分别为17例、30例、49例、14例,其中Ⅲ型是最主要的分型,占44.5％,两组分型分布差异有统计学意义（P＜0.05）.OVCF组L1、L2椎体骨折占总体的82.4％,骨折节段与腰椎Roussouly分型存在显著相关性（P=0.034）.结论 新鲜腰椎OVCF患者的重心前移、矢状位失衡,导致骨盆后旋转、PT增大、SS减小,同时腰椎曲线顶点下移,Rou-ssouly分型以Ⅰ、Ⅱ型为主.

Objective To investigate the effects of fresh lumbar osteoporotic vertebral compression fracture （OVCF） on spinopelvic sagittal parameters and distribution of Roussouly types.Methods One hundred and eight patients with one-level fresh lumbar OVCF and 110 patients with simple osteoporosis （OP） were diagnosed and treated at Department of Orthopedic Surgery,Shougang Hospital from January 2016 to August 2017.The basic clinical data of all the patients were documented and their lumber spines were classified by Roussouly types.The 2 groups were compared in terms of spinopelvic sagittal parameters such as pelvic incidence （PI）,pelvic tilt （PT）,sacral slope （SS）,and lumbar lordosis （LL） and Roussouly types.The correlation between Roussouly types and fracture segments was observed in OVCF group.Results There was no significant different in PI between OVCF and OP groups （50.35° ± 11.00° versus 51.96° ± 11.73°） （P 〉 0.05）.PT in OVCF group （18.79°± 9.51°） was significantly larger than that （16.19°± 9.03°） in OP group while SS （31.56° ± 7.88°） and LL （40.22°± 12.29°） in the former significantly smaller than those in the latter （35.77° ± 8.82° and 47.89° ± 13.20°,respectively） （P 〈 0.05）.Roussouly types Ⅰ,Ⅱ,Ⅲ and Ⅳ in OVCF group were 35,40,28 and 5 cases,respectively,with types Ⅰ and Ⅱ accounting for 69.5%;Roussouly types Ⅰ,Ⅱ,Ⅲ and Ⅳ in OP group were 17,30,49 and 14 cases,respectively,with type Ⅲ being predominant （44.5%）.There was a significant difference between the 2 groups in distribution of Roussouly types （P 〈03.05）.In OVCF group,fractures of L1 and L2 vertebrae accounted for 82.4%.There was a significant correlation between fracture segments and lumbar Roussouly types （P =0.034）.Conclusions Patients with fresh lumbar OVCF tend to have a forward gravity and sagittal disequilibrium,leading to posterior pelvic rotation,increased PT,decreased SS,and downward shift of the apex of the lumbar curve.Their Roussouly classification is mainly type Ⅰ or type Ⅱ.