骨质疏松对老年人脊柱-骨盆矢状位参数影响的研究

Effects of Osteoporosis on the Sagittal Spine-pelvic Parameters in Elderly Patients

目的探讨骨质疏松对老年人脊柱-骨盆矢状位参数的影响。方法选取2020年6月至2021年6月华中科技大学同济医学院附属协和医院骨科骨质疏松专科门诊接诊的115例骨质疏松患者作为观察组,其中男21例,女94例;年龄58~79岁,平均(67.76±9.17)岁。选择同时期来本院健康查体的60例无骨质疏松的志愿者作为对照组。其中男18例,女42例;年龄54~76岁,平均(65.25±10.38)岁。应用低辐射X线机拍摄站立位包括髋关节在内的脊柱侧位X线片以评估脊柱-骨盆矢状位形态。测量胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvictilt,PT)、骶骨倾斜角(sacral slope,SS)和矢状面垂直轴(sagittal vertical axis,SVA);应用相关性系数(intraclass correlation coefficient,ICC)评估观察者内和观察者间测量数据的可信度。比较两组病例脊柱-骨盆矢状位参数,以分析骨质疏松对老年人脊柱-骨盆矢状位参数的影响。结果影像学测量ICC为0.90~0.95。观察组和对照组在SVA、SS、PT、LL、TK方面差异有统计学意义(P<0.05)。观察组的PI与对照组相比差异无统计学意义(P>0.05)。结论骨质疏松可引起老年人脊柱-骨盆矢状位参数发生改变,以矢状面垂直轴、骶骨倾斜度、骨盆倾斜度、腰椎前凸和胸椎后凸改变为主,骨盆入射角则相对恒定。

Objective To investigate the effects of osteoporosis on the sagittal spine-pelvic parameters in elderly patients.Methods 115 patients with osteoporosis received from the osteoporosis specialist outpatient clinic of Department of Orthopedics in Union Hospital of Tongji Medical College from June 2020 to June 2021 were selected as the observation group.21 males and 94 females were included.The age ranged form 58 to 79,with an average age of(67.76±9.17)years.60 patients without osteoporosis who came to our hospital for health examination during the same period were selected as the control group including 18 males and 42 females.The age ranged form 54 to 76,with an average age of(65.25±10.38)years.Low-radiation X-ray machine was used to take lateral X-rays of the spine including the hip joint in the standing position to assess the spine-pelvic sagittal morphology.Thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)and the sagittal vertical axis(SVA)were measured.The intraclass correlation coefficient(ICC)was used to evaluate the reliability of the intra-observer and inter-observer.The spine-pelvic sagittal parameters of the two groups were compared to analyze the effects of osteoporosis on the sagittal spine-pelvis parameters in elderly patients.Results The intra-observer and inter-observer ICC were 0.90~0.95.There were significant differences between the observation group and the control group in SVA,SS,PT,LL and TK(P<0.05).PI of the observation group was not statistically different from that of the control group(P>0.05).Conclusion The sagittal spinopelvic parameters in elderly patients change mainly in SVA,SS,PT,LL and TK after osteoporosis,while the PI is relatively constant.