退变性脊柱侧凸主弯区的退变程度分析

Analysis of degeneration degree in the main curvature region of degenerative scoliosis

背景:退变性脊柱侧凸的发病机制不清,主弯区非对称退变可能与侧凸发生、发展紧密相关,充分认识主弯区的退变有助于为临床治疗策略提供更多参考。目的:探讨退变性脊柱侧凸主弯区退变程度与脊柱骨盆参数之间的关系,了解其发病机制。方法:收集西南医科大学附属医院脊柱外科2018年7月至2023年11月就诊的退变性脊柱侧凸患者的病历及影像学资料。比较顶椎上、下关节突关节凹侧、凸侧关节炎的差异;分析脊柱侧凸严重程度、脊柱骨盆参数、关节突关节炎等参数之间的相关性;探究脊柱侧凸严重程度、脊柱骨盆参数、关节突关节炎等参数之间的影响作用。结果与结论:①在顶椎关节突关节中,凹侧比凸侧关节突关节炎严重,差异有显著性意义(P<0.001);在顶椎同侧(凹侧或凸侧)上关节突关节炎比下关节突关节炎严重,差异有显著性意义(P<0.001);②骨盆入射角随着腰椎前凸角减小而减小(rs=0.509,P<0.001);顶椎侧方骨赘差值随着腰椎前凸角减小而增加(rs=-0.285,P=0.033);关节突关节不对称角随着骨盆入射角减小而增加(rs=-0.379,P=0.004);③L5倾斜角、椎间盘角度是主弯Cobb角增大的危险因素(B=1.012,P<0.001;B=0.620,P=0.016);骨盆入射角是主弯Cobb角增大的保护因素(B=-0.264,P=0.003);④提示退变性脊柱侧凸顶椎区域凹侧退变程度重于凸侧;顶椎关节突关节不对称角及关节突关节炎严重程度与脊柱侧凸严重程度无明显相关性;腰椎前凸角和骨盆入射角在维持脊柱正常序列中发挥关键作用,且骨盆入射角是主弯Cobb角增大的保护因素;L5倾斜角和椎间盘角度是主弯Cobb角增大的危险因素。

BACKGROUND:The pathogenesis of degenerative scoliosis is unclear,and asymmetric degeneration of the main curvature region may be strongly associated with the onset and progression of scoliosis.Fully recognizing the degeneration of the main curvature region can help to inform more clinical treatment strategies.OBJECTIVE:To explore the relationship between the degree of degeneration in the main curvature region and the parameters of the spinal pelvis in patients with degenerative scoliosis and to understand its pathogenesis.METHODS:The medical records and imaging data of patients with degenerative scoliosis admitted to Department of Spine Surgery,Affiliated Hospital of Southwest Medical University from July 2018 to November 2023 were collected.The difference in the facet joint osteoarthritis between concave and convex sides of the superior and inferior facet joints of the apical vertebra was compared to analyze the correlation between parameters such as the severity of scoliosis,spinopelvic parameters,and facet joint osteoarthritis and to explore the influencing effect between parameters such as the severity of scoliosis,spinopelvic parameters,and facet joint osteoarthritis.RESULTS AND CONCLUSION:(1)Among the facet joint of the apical vertebra,concave side was more severe than convex side with facet joint osteoarthritis,with a statistically significant difference(P<0.001).On the same side(concave or convex side)of the apical vertebra superior facet joint osteoarthritis was more severe than inferior facet joint osteoarthritis,with a statistically significant difference(P<0.001).(2)The pelvic incidence decreased with decreasing lumbar lordosis(rs=0.509,P<0.001).The lateral osteophyte difference increased with decreasing lumbar lordosis(rs=-0.285,P=0.033).The facet joint tropism increased with decreasing pelvic incidence(rs=-0.379,P=0.004).(3)The L5 tilt angle and disc angle were risk factors for increased main curve Cobb angle(B=1.012,P<0.001;B=0.620,P=0.016).Pelvic incidence was a protective factor against the increase of the main curve Cobb angle(B=-0.264,P=0.003).(4)It is concluded that in cases of degenerative scoliosis,the degree of degeneration on the concave side was significantly heavier than that on the convex side at the apical vertebra.There was no significant correlation between the severity of facet joint tropism and facet joint osteoarthritis and the severity of scoliosis.Lumbar lordosis and pelvic incidence played key roles in maintaining the normal spinal sequence.Pelvic incidence was a protective factor against the increase of the main curve Cobb angle.L5 tilt angle and disc angle were the risk factors for the increase of the main curve Cobb angle.