骨质疏松退变性腰椎侧凸的影像学表现及临床特征

Radiological Features and Clinical Findings in Degenerative Lumbar Scoliosis with Osteoporosis

目的 评估伴骨质疏松的退变性腰椎侧凸的影像学形态及临床特征。方法 纳入2017年11月至2021年12月27例骨质疏松性退变性腰椎侧凸患者作为骨质疏松组,其中男5例,女22例;年龄51~79岁,平均(68.1±7.4)岁。同时选取27例非骨质疏松性退变性腰椎侧凸患者作为非骨质疏松组,其中男8例,女19例;年龄53~76岁,平均(66.3±6.9)岁。记录两组骨密度T值与临床症状,测量并比较两组患者站立位全脊柱X线片上各项影像学参数,进一步分析骨质疏松组骨密度T值与各影像学参数之间的相关性。结果 骨质疏松组平均T值(-3.0±0.6),显著低于非骨质疏松组(-0.6±1.4)。两组腰痛、肌力减退与感觉异常占比的比较差异无统计学意义(P>0.05)。骨质疏松组左腰弯13例,右腰弯14例。非骨质疏松组左腰弯11例,右腰弯16例。两组腰弯及胸弯的Cobb角、顶椎偏移、顶椎旋转、胸椎后凸角、腰椎前凸角、冠状位及矢状位躯干偏移的比较差异均无统计学意义(P>0.05)。骨质疏松组中T值与胸椎后凸角存在明显的相关性(r=-0.568,P=0.022)。结论 伴骨质疏松的退变性腰椎侧凸患者的冠矢状面形态与非骨质疏松性患者相近,伴骨质疏松的退变性腰椎侧凸患者的骨质疏松程度与胸椎后凸角呈现相关性。

Objective To evaluate the radiological features and clinical findings in osteoporotic patients with degenerative lumbar scoliosis(DLS).Methods From November 2017 to December 2021,27 DLS patients combined with osteoporosis(OP) were enrolled as OP group.The OP group had 5 male and 22 femaile patients and had an average age of(68.1±7.4) years(51~79 years).At the same time, another 27 DLS patients without osteoporosis were recruited as the non-osteoporosis(NOP) group.The NOP group had 8 males and 19 females and had an average age of(66.3±6.9) years(53~76 years).Bone mineral density(T-score) and clinical symptoms were recorded.The radiographic parameters were measured in standing full spine X-ray film and further compared between two groups.The correlation between the T-score and radiographic parameters was analyzed in the OP group.Results The median T-score in the OP group(-3.0±0.6) was significantly lower than that in the NOP group(-0.6±1.4).The percentage of back pain, motor deficit and sensory deficit were comparable between two groups(P>0.05).There were 13 left lumbar curves and 14 right lumbar curves in the OP group.There were 11 left lumbar curves and 16 right lumbar curves in the NOP group.No significant differences were observed in terms of radiographic parameters including lumbar and thoracic cobb angle, apical vertebral translation, apical vertebral rotation, thoracic kyphosis, lumbar lordosis, coronal and sagittal trunk shift(P>0.05).A significant correlation was found between T-score and thoracic kyphosis in OP group(r=-0.568,P=0.022).Conclusion The coronal and sagittal profile are comparable between DLS patients with and without osteoporosis.The severity of osteoporosis is obviously correlated with thoracic kyphosis in osteoporotic patients.