正常国人脊柱骨盆矢状位排列与腰椎间盘退变的关系研究

Correlation between Sagittal Spino-pelvic Alignment and Lumbar Disc degeneration in Asymptomatic Chinese Adults

目的分析正常中国成人脊柱骨盆矢状位排列特点,探讨脊柱骨盆矢状位排列与腰椎间盘退变的关系。方法前瞻性的对148例正常中青年志愿者进行全脊柱站立正、侧位X线及腰椎磁共振检查,测量各脊柱骨盆矢状位参数,确定脊柱骨盆矢状位分型,并分析脊柱骨盆矢状位各参数值及排列类型与腰椎间盘退变之间的关系。结果胸椎后凸角(TK)、腰椎前凸角(LL)与L_(4/5)椎间盘退变呈正相关(r=0.188,P=0.022;r=0.165,P=0.045),骨盆倾斜角(PT)与L_(5)/S_(1)椎间盘退变呈正相关(r=0.187,P=0.023)。148例志愿者中RoussoulyⅠ型、Ⅱ型、Ⅲ型、Ⅳ型比例分别为5.4%、41.2%、36.5%和16.9%,腰椎间盘退变的发生率分别为7.5%、20.3%、12.6%和13.6%;L_(5)/S_(1)节段Ⅱ型的椎间盘退变率明显高于Ⅲ、Ⅳ型(χ^(2)=6.208,P=0.018;χ^(2)=4.468,P=0.049)。结论腰椎间盘退变会受到脊柱骨盆矢状位形态的影响,TK、LL、PT与下位腰椎间盘(L_(4/5)、L_(5)/S_(1))的退变相关。正常国人中41.2%的脊柱矢状位排列类型为RoussoulyⅡ型,RoussoulyⅡ型的中国成人腰椎间盘退变的发生率高,并且更易发生L_(5)/S_(1)椎间盘的退变。

Objective To analyze the characteristics of sagittal spino-pelvic alignment in asymptomatic Chinese adults,and to explore the correlation between sagittal spino-pelvic alignment and lumbar disc degeneration.Methods A total of 148 asymptomatic young and middle-aged volunteers were prospectively examined by standing anteroposterior and lateral radiographs of the whole spine and lumbar magnetic resonance imaging.The sagittal spino-pelvic parameters were measured,sagittal spino-pelvic alignment patterns were determined,and the correlations between sagittal spino-pelvic parameters,alignment patterns and lumbar disc degeneration were analyzed.Results There was a positive correlation between thoracic kyphosis(TK),lumbar lordosis(LL)and degeneration of L_(4/5)intervertebral disc(r=0.188,P=0.022;r=0.165,P=0.045).Pelvic tilt(PT)was positively correlated with disc degeneration at L_(5)/S_(1)(r=0.187,P=0.023).The proportion of Roussouly typeⅠ,Ⅱ,Ⅲ,Ⅳwas 5.4%,41.2%,36.5%,16.9%respectively,and the incidence of lumbar disc degeneration was 7.5%,20.3%,12.6%,13.6%respectively.The incidence of lumbar disc degeneration of Roussouly typeⅡwas higher than typeⅢ,Ⅳat L_(5)/S_(1)(χ^(2)=6.208,P=0.018;χ^(2)=4.468,P=0.049).Conclusion Degeneration of the lumbar disc may be affected by sagittal spino-pelvic alignment.TK,LL and PT are associated with degeneration of lower lumbar intervertebral discs(L_(4/5),L_(5)/S_(1)).41.2%of asymptomatic Chinese adults possess a sagittal posture of Roussouly typeⅡ.Roussouly typeⅡsagittal alignment subtype has a higher incidence of lumbar disc degeneration,and is more prone to the occurrence of disc degeneration at L_(5)/S_(1).