汉族男性青年志愿者不同体位脊柱-骨盆矢状位参数变化的影像学研究

The imaging study on the changes of sagittal parameters of different positional spine-pelvis in young Han men

目的对比汉族青年男性志愿者站立位、直立坐位和自然坐位X线的脊柱-骨盆矢状位参数差异,评估骨盆旋转对矢状位平衡的影响.方法采用横断面研究.2017年9—10月,在南京鼓楼医院骨科的研究生中招募志愿者32人,均为汉族男性,年龄23~27(24.8±1.6)岁,身高171~185(176.4±5.3)cm,体质量57.7~88.4(69.5±8.6)kg,体质量指数(BMI)21.2~24.7(22.5±2.3)kg/m2.应用EOS-X线成像系统,采用垂直扫描方式,人体全长影像一次扫描成像,结合常用的拍摄方式进行站立位、直立坐位、自然坐位拍摄.影像学测量参数包括胸椎后凸角(TK)、腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆入射角(PI)、骨盆倾斜角(PT)以及脊柱的矢状位偏移(SVA)、T1骨盆角(TPA).采用配对样本t检验比较不同体位时影像学参数的变化情况,对脊柱-骨盆参数之间关系采用Pearson相关性分析.结果32名志愿者,站立位时PI、PT、SS、LL、TK、SVA、TPA分别为49.06°±6.22°、13.38°±6.06°、35.03°±2.32°、-47.16°±7.64°、32.22°±9.74°、(3.29±13.64)mm、9.47°±5.26°,直立坐位时分别为48.22°±6.07°、29.06°±10.35°、18.84°±5.90°、-26.38°±8.45°、31.78°±9.95°、(34.73±13.62)mm、26.06°±8.71°,自然坐位时分别为49.22°±6.20°、40.50°±10.42°、9.84°±4.87°、-4.03°±6.14°、31.69°±9.73°、(63.37±13.70)mm、49.66°±11.22°.与站立位各参数值比较,直立坐位与自然坐位PT、SVA、TPA增加,SS、LL减少;与直立坐位比较,自然坐位PT、SVA、TPA增加,SS、LL减少:差异均有统计学意义(P值均<0.05).脊柱-骨盆矢状位参数之间的Pearson相关性分析结果显示:(1)站立位时,PI与PT、LL、TK、TPA呈相关性,PT与LL、TK、TPA呈相关性,LL与TK、TPA呈相关性,TK与TPA呈相关性;(2)直立坐位时,PI与PT、SS、LL、TK、TPA呈相关性,PT与SS、LL、TK、TPA呈相关性,SS与LL、TK、TPA呈相关性,LL与TK、TPA呈相关性,TK与TPA呈相关性;(3)自然坐位时,PI与PT、SS、LL、TK、TPA呈相关性,PT与SS、LL、TK、TPA呈相关性,SS与LL、TK、TPA呈相关性,LL与TK、TPA呈相关性.这些相关性差异均有统计学意义(P值均<0.05).结论正常汉族青年男性从站立位到直立坐位、直立坐位到自然坐位的过程中,LL减小,SVA、TPA显著增大,提示躯干矢状位平衡轴前移、骨盆向后旋转.脊柱参数与骨盆参数存在一定的相关性,骨盆的位置改变可以影响到脊柱的序列与平衡.

Objective To compare the spine-pelvic sagittal parameters of the healthy and young Han males in standing,erect sitting and natural sitting.Evaluate the effect of pelvic rotation on sagittal balance.Methods This was a cross-sectional study.Thirty-two volunteers were recruited from the graduate students of Nanjing Drum Tower Hospital from September 2017 to October 2017.All the volunteers were males,aged between 23 to 27(24.8±1.6)years old,171-185(176.4±5.3)cm in height,57.7-88.4(69.5±8.6)kg in weight,and BMI 21.2-24.7(22.5±2.3)kg/m2.EOS-X-ray imaging system was applied to all subjects,and vertical scanning method was adopted.Full-length images were scanned once,and standing position,erect sitting and natural sitting position were taken.Parameters were measured included thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),pelvic incidence(PI),pelvic tilt(PT),sagittal vertical axis(SVA),T1 pelvic angle(TPA).Paired-samples T test was used to compare the changes of parameters in different positions,and Pearson correlation analysis was used to analyze the relationship between spinopelvic parameters.Results For 32 volunteers,in standing position,the average PI was 49.06°±6.22°,PT was 13.38°±6.06°,SS was 35.03°±2.32°,LL was-47.16°±7.64°,TK was 32.22°±9.74°,SVA was(3.29±13.64)mm,TPA was 9.47°±5.26°.In erect sitting position,the average PI was 48.22°±6.07°,PT was 29.06°±10.35°,SS was 18.84°±5.90°,LL was-26.38°±8.45°,TK was 31.78°±9.95°,SVA was(34.73±13.62)mm,TPA was 26.06°±8.71°.In natural sitting position,the average PI was 49.22°±6.20°,PT was 40.50°±10.42°,SS was 9.84°±4.87°,LL was-4.03°±6.14°,TK was 31.69°±9.73°,SVA was(63.37±13.70)mm,TPA was 49.66°±11.22°.Compared with the parameters of standing position,PT,SVA and TPA parameters of erect and natural sitting position increased,SS and LL parameters decreased.Compared with the parameters of erect sitting position:PT,SVA and TPA parameters of natural sitting position increased,SS and LL parameters decreased.The differences were statistically significant(all P values<0.05).Pearson correlation analysis results showed that:(1)In standing position,PI was correlated with PT,LL,TK and TPA.PT was correlated with LL,TK and TPA.LL was correlated with TK and TPA.TK was correlated with TPA.(2)In erect sitting position,PI was correlated with PT,SS,LL,TK and TPA.PT was correlated with SS,LL,TK and TPA.SS was correlated with LL,TK and TPA.LL was correlated with TK and TPA.TK was correlated with TPA.(3)In natural sitting position,PI was correlated with PT,SS,LL,TK and TPA.PT was correlated with SS,LL,TK and TPA.SS was correlated with LL,TK and TPA.LL was correlated with TK and TPA.Differences were statistically significant(all P values<0.05).Conclusions In the process of from the standing position to the upright sitting position,the upright sitting position to the natural sitting position,Han people the LL of normal Han young men is decreasing and SVA,TPA are increasing.It indicates that SVA moves anteriorly and the pelvic rotates posteriorly.Some correlation between spinal parameters and pelvic parameters are also shown.The changing of pelvis can influence the sagittal alignment and balance of the spine.