1~10岁儿童腰骶段曲度生长变化规律的MRI研究

MRI study on curvature change rules of lumbosacral segment in children aged 1-10 years

目的探讨1~10岁儿童腰骶曲度的生长变化规律。方法横断面研究。纳入2021年7月—2023年7月在山东省立医院经MRI证实腰骶椎体未见异常的90例正常发育儿童。患儿男52例、女38例, 年龄1~10(6.1±2.7)岁。按年龄分为4组:1~3岁组20例、4~6岁组24例、7~8岁组24例、9~10岁组22例。测量参数:腰椎前凸角(LLA)、腰骶前凸角(LSLA)、骶骨倾斜角(ST)、骶骨水平倾角(SIA)、腰骶前凸大小(d=180°-LSLA)。观察指标:(1)比较不同年龄组间参数LLA、d、ST及SIA的差异;(2)比较不同年龄组内参数的性别间差异及相同性别不同年龄组间参数的差异;(3)分析各参数之间的相关性, 以及年龄与各参数间的相关性;(4)以d值为因变量构建线性回归方程。结果正常1~10岁儿童LLA为5°~43°(22.8°±7.2°), LSLA为137°~163°(150.5°±5.5°), ST为30°~57°(42.3°±5.3°), SIA为16°~43°(28.7°±5.5°), d为17°~43°(29.5°±5.5°)。(1)不同年龄组间各参数比较:多组间比较LLA差异有统计学意义(F=3.13, P=0.030);两两比较仅7~8岁组与1~3岁组LLA差异有统计学意义(P=0.026), 差值(95%CI)为6.2°(0.5°~11.8°);d、ST、SIA值多组间及两两比较差异均无统计学意义(P值均>0.05)。(2)不同年龄组内各参数的性别间比较:4~6岁组女性LLA值(26.4°±6.6°)高于男性(20.1°±6.9°)、女性d值(30.7°±6.5°)高于男性(25.8°±5.1°), 差值(95%CI)分别为6.3°(0.8°~11.7°)、4.9°(0.9°~9.0°), 差异均有统计学意义(P值均<0.05);9~10岁组女性ST值(46.4°±4.7°)高于男性(41.3°±5.5°)、女性d值(35.0°±4.4°)高于男性(28.4°±4.9°), 差值(95%CI)分别为5.1°(0.6°~9.6°)、6.6°(2.2°~11.0°), 差异均有统计学意义(P值均<0.05)。相同性别各参数的不同年龄组间比较:女性儿童9~10岁组d值(35.0°±4.4°)明显大于1~3岁组(27.3°±4.1°), 差值(95%CI)为7.7°(1.0°~14.4°), 差异有统计学意义(P=0.017);(3)LLA、d、ST及SIA间均呈中度正相关(r=0.576~0.708, P值均<0.05), 年龄与LLA、d均呈低度正相关(r_(s)=0.261、0.279, P值均<0.05)。(4)构建线性回归方程:Y_(d)=7.394+0.320XLLA+0.250XST(R^(2)=0.551, P<0.001)。结论 1~10岁儿童生长过程中, 腰骶段曲度参数d始终大于LLA;LLA从19°增加到25°, 变化的峰值出现在7~8岁;女孩d值从27°增加到35°, 变化的峰值出现在9~10岁。LLA、d与年龄呈低度正相关;LLA、d、ST及SIA各参数间均存在相关性, 腰骶前凸受腰椎前凸及骶骨后凸共同影响。

Objective This study aimed to investigate the growth change rules of lumbosacral curvature with in children aged 1-10 years.Methods This was a cross-sectional study.A total of 90 normally developing children with no abnormal lumbosacral vertebrae confirmed by MRI in Shandong Provincial Hospital from July 2021 to July 2023 were included.Among the children,52 were males and 38 were females aged 1-10(6.1±2.7)years.They were divided into four groups according to age:1-3 years(20 children),4-6 years(24 children),7-8 years(24 children),and 9-10 years(22 children).The measurement parameters were as follows:lumbar lordosis angle(LLA),lumbosacral lordosis angle(LSLA),sacral tilt(ST),sacral inclination angle(SIA),and lumbosacral lordosis size(d=180°-LSLA).The outcome measures were as follows:(1)The differences of parameters among different age groups were compared.(2)The gender differences among different age groups and the difference between groups of the same sex were compared.(3)The correlation between parameters and between age and parameters were analyzed.(4)The linear regression equation was constructed with d value as the dependent variable.Results LLA value,LSLA value,ST value,SIA,and d value were 5°-43°(22.8°±7.2°),137°-163°(150.5°±5.5°),30°-57°(42.3°±5.3°),16°-43°(28.7°±5.5°),and 17°-43°(29.5°±5.5°)in normal children aged 1 to 10 years.(1)Comparison of parameters among different age groups revealed the following.The difference in LLA value was statistically significant(F=3.13,P=0.030),and only the difference between the groups aged 7-8 and 1-3 years was statistically significant(P=0.026).The difference value(95%CI)was 6.2°(0.5°-11.8°).No significant differences were found in the d,ST,and SIA values(all P values>0.05).(2)The LLA value(26.4°±6.6°)and d value(30.7°±6.5°)in females were higher than those in males(20.1°±6.9°and 25.8°±5.1°)in 4-6 years old group,and the difference(95%CI)were 6.3°(0.8°-11.7°)and 4.9°(0.9°-9.0°),respectively.The differences were statistically significant(all P values<0.05).The ST value of females(46.4°±4.7°)was higher than that of males(41.3°±5.5°),the d value of females(35.0°±4.4°)was higher than that of males(28.4°±4.9°),and the difference value(95%CI)was 5.1°(0.6°-9.6°)and 6.6°(2.2°-11.0°)in the group aged 9-10 years.The above differences were statistically significant(all P values<0.05).In female children,the d value of the group aged 9-10 years(35.0°±4.4°)was significantly higher than that of the group aged 1-3 years(27.3°±4.1°),the difference value(95%CI)was 7.7°(1.0°-14.4°),and the difference was statistically significant(P=0.017).(3)The positive correlations among all parameters(r=0.576-0.708,all P values<0.05)were moderate,and the positive correlations between age and LLA and between age and d(r_(s)=0.261,0.279;all P values<0.05)were low.The linear regression equation was Y_(d)=7.394+0.320XLLA+0.250XST(R^(2)=0.551,P<0.001).Conclusion The d value always exceed LLA during the growth of children aged 1-10 years.LLA increased from 19°to 25°,and the peak of the change occurr at 7-8 years old.The d value of girls increases from 27°to 35°,and the peak change occurs at 9 to 10 years of age.The positive correlations between age and LLA and between age and d,are low.The positive correlations among LLA,d,ST,and SIA parameters are moderate.Lumbosacral lordosis is influenced by lumbar lordosis and sacral kyphosis.