髋、膝关节疾病患者脊柱—骨盆—下肢矢状面形态变化的初步研究

发布时间：2018-06-24 17:42

本文选题：膝骨性关节炎 + 矢状面平衡　；参考：《南京医科大学》2015年硕士论文

【摘要】：第一部分:膝关节骨关节炎患者脊柱-骨盆-下肢矢状面形态变化的初步研究目的:通过比较膝关节骨性关节炎(knee osteoarthritis,KOA)患者与正常人的矢状面相关参数,探讨KOA患者矢状面形态异常及其临床意义。方法:研究收集正常人58例、KOA患者75例的站立位全脊柱侧位X线片并测量下列参数:(1)脊柱矢状面参数:脊柱骶骨角(spinal-sacral angle,SSA)、脊柱前倾角(spinal tilt,ST/C7T)、腰椎前凸角(lumbar lordosis,LL);(2)骨盆及相关下肢矢状面参数:骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);股骨倾斜角(femoral inclination,FI)。采用独立样本t检验分析组间各矢状面参数间的差异性,同时应用Pearson相关性分析KOA组各个参数相关性。结果:KOA组FI(11.1±4.9)较正常对照组(4.2±3.5)增大,但SFA(42.7±11.4)和PFA(2.0±8.7)值较正常对照组(SFA:51.8±8.5;PFA:9.1±8.1)减小,且差异均有统计学意义(p0.05);此外KOA组ST(88.9±4.3)值较正常对照组(92.9±3.5)减小,且差异有统计学意义(p0.05);而SS、PT和PI值与正常对照组相近,且差异无统计学意义(p0.05)。KOA组SFA与PFA存在明显正相关(r=0.494),而与FI则存在明显负相关(r=-0.668);PFA与FI存在明显负相关(r=-0.586)。结论:KOA患者膝关节明显屈曲,导致其脊柱和骨盆前倾。KOA患者的这些矢状面形态在行全膝关节置换术设计时需要加以考虑。第二部分:膝关节骨关节炎患者脊柱-骨盆-下肢矢状面形态变化与腰痛关系的初步研究目的:对KOA患者的脊柱-骨盆-下肢矢状面形态进行测量分析,并与正常人进行比较,明确KOA患者的矢状面形态、相关机制及临床意义,并探究慢性腰痛继发于KOA的可能机制。方法:研究收集正常人58例、KOA患者75例的站立位全脊柱侧位X线片并测量下列参数:(1)脊柱矢状面参数:脊柱骶骨角(spinal-sacral angle,SSA)、脊柱前倾角(spinal tilt,ST/C7T)、腰椎前凸角(lumbar lordosis,LL);(2)骨盆及相关下肢矢状面参数:骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);股骨倾斜角(femoral inclination,FI);腰痛评分(Visual analogue score,VAS)。采用独立样本t检验分析组间各矢状面参数间的差异性,同时应用Pearson相关性分析KOA组各个参数相关性。根据C7铅垂线到骨盆的相对位置,将脊柱-骨盆平衡分为三类。结果:KOA组FI(11.1±4.9)较正常对照组增大,但SFA(42.7±11.4)和PFA(2.0±8.7)值较正常对照组减小,且差异均有统计学意义(p0.05);此外KOA组ST(88.9±4.3)值较正常对照组减小,且差异有统计学意义(p0.05);FI≤10°的患者,相比对照组LL减小,FI和C7T明显减小,但骨盆(PT,PI,SS)和髋关节屈曲(SFA,PFA)参数没有差别。相反地,FI10°的患者,相比对照组FI和SS显著增大,但C7T、SFA和PFA减小。比较KOA组的两个子组之间的这些参数后,我们发现,与FI≤10°组相比FI10°组C7T,SFA和PFA明显减小,但FI却明显增大。另外,FI10°组LL较FI≤10°组明显增大。与正常对照组相比KOA组有严重的脊柱-骨盆矢状面失平衡,且FI10°组较FI≤10°组更易出现矢状面的失平衡。结论:KOA患者膝关节明显屈曲,导致其脊柱和骨盆前倾。FI≤10o的膝关节骨性关节炎患者腰椎将作为代偿轻度膝关节屈曲,LL减小。然而,严重的患者膝关节屈曲(FI10°),脊柱、骨盆和髋关节都参与了矢状面的代偿,表现为脊柱前倾、骨盆前倾和髋关节屈曲。腰椎前凸的减小和脊柱前倾可加快慢性腰痛在这些患者的发展或恶化。第三部分:Crowe IV型DDH患者脊柱-骨盆-下肢矢状面平衡状态异常及其临床意义目的:通过比较Crowe IV型髋关节发育不良患者(Developmental dysplasia of hip,DDH)与正常人和原发性髋骨性关节炎患者(hip osteoarthritis,HOA)的矢状面相关参数,探讨DDH患者矢状面形态异常及其临床意义。方法:研究收集正常人40例、HOA患者30例和双侧Crowe IV型DDH患者16例的站立位全脊柱侧位X线片并测量下列参数:(1)骨盆矢状面参数:骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骶骨骨盆角(sacrum pubic incidence,SPI)、骶骨股骨角(sacrum femoral angle,SFA)、骨盆股骨角(pelvic femoral angle,PFA);(2)脊柱矢状面参数:脊柱前倾角(spinal tilt,ST)、腰椎前凸角(lumbar lordosis,LL);(3)下肢矢状面参数:股骨倾斜角(femoral inclination,FI)。采用ANOVA检验分析各组间各矢状面参数间的差异性,同时进行各组间各个参数的可信度比较分析。结果:三组间年龄、性别分布差异无统计学意义。DDH组的PI可信度(a=0.008)较正常对照(a=0.350)及HOA组(a=0.276)低。DDH组SS(45.6±12.09)、PT(16.7±8.81)、PI(55.3±16.63)、PFA(12.7±15.15)、SPI(76.4±10.87)、FI(14.3±7.12)均较HOA组增大,且差异有统计学意义(P0.05);LL(37.3±15.87)、ST(87.8±5.43)均与HOA组相近,且差异无统计学意义,但与正常对照组相比差异均有统计学意义(P0.05)。结论:DDH患者较HOA患者骨盆更加前倾,导致其脊柱前倾,髋、膝关节屈曲。DDH患者的这些矢状面形态在行全髋关节置换术设计时需要加以考虑。
[Abstract]:The first part: preliminary study on the morphological changes of the spinal - pelvis and lower extremity in patients with osteoarthritis of the knee. Objective: To investigate the abnormal sagittal morphology of the patients with knee osteoarthritis (KOA) and the normal human sagittal plane, and to explore the clinical significance of the abnormal sagittal plane in KOA patients. Methods: 58 cases of normal people were collected, KOA The following parameters of the standing total spinal lateral position were measured in 75 patients: (1) the parameters of the sagittal plane of the spine: spinal-sacral angle, SSA, spinal tilt, ST/C7T, lumbar lordosis, LL; (2) the pelvic and related lower extremity sagittal parameters: pelvic projection angle (pelvic incidence, PI) Acral slope, SS), pelvic inclination angle (pelvic tilt, PT), sacral femoral angle (sacrum femoral angle, SFA), pelvis femur angle (pelvic femoral), and femur inclination angle. Results: in group KOA, FI (11.1 + 4.9) was higher than that of normal control group (4.2 + 3.5), but SFA (42.7 + 11.4) and PFA (2 + 8.7) were lower than normal control group (SFA:51.8 + 8.5; PFA:9.1 + 8.1), and the difference was statistically significant (P0.05); moreover, the ST (88.9 + 4.3) value of KOA group was lower than that of normal control group (P0.05), and the difference was statistically significant (P0.05); S The values of S, PT and PI were similar to those of the normal control group, and the difference was not statistically significant (P0.05) there was a significant positive correlation between SFA and PFA in.KOA group (r=0.494), but there was a significant negative correlation with FI (r=-0.668); PFA was negatively correlated with FI. The second part: a preliminary study of the relationship between the morphological changes of the spine to the pelvis and the sagittal plane and the low back pain in patients with osteoarthritis of the knee: the measurement and analysis of the spinal - pelvis and lower extremities in KOA patients, and to compare with the normal people to make clear the sagittal of the KOA patients. Shape, mechanism and clinical significance, and to explore the possible mechanism of chronic low back pain secondary to KOA. Methods: To study 75 cases of normal people and 75 cases of standing total spinal lateral X ray and measure the following parameters: (1) spinal sagittal plane parameters: spinal-sacral angle (SSA), spinal tilt (ST/C7T), lumbar spine (ST/C7T), lumbar spine, and lumbar spine (spinal tilt, ST/C7T), waist Lumbar lordosis (LL); (2) pelvic and related lower limb sagittal parameters: pelvic projection angle (pelvic incidence, PI), sacral tilting angle (sacral slope, SS), pelvic inclination (pelvic tilt, PT), sacral femoral angle, pelvis femur angle; femur inclination angle; Visual analogue score (VAS). An independent sample t test was used to analyze the differences between the parameters of the sagittal plane between the groups, and the correlation of the parameters of the KOA group was analyzed with the Pearson correlation. The spinal pelvic balance was divided into three categories according to the relative position of the C7 plumb line to the pelvis. Results: the KOA group FI (11.1 + 4.9) was higher than that of the normal control group. But the values of SFA (42.7 + 11.4) and PFA (2 + 8.7) were smaller than those in the normal control group (P0.05), and the ST (88.9 + 4.3) values in the KOA group were lower than those in the normal control group, and the difference was statistically significant (P0.05). The LL decreased and the FI and C7T decreased significantly in the patients with FI < 10 degrees, but the pelvis (PT, PI, etc.) and the hip joint flexion. FA) parameters were not different. On the contrary, the patients with FI10 degrees were significantly larger than the control group FI and SS, but C7T, SFA and PFA decreased. After comparing the parameters between the two subgroups of the KOA group, we found that the FI10 degree group was significantly smaller than the FI < 10 degree group. Compared with the KOA group, the normal control group had severe spinal - pelvic sagittal imbalance, and the FI10 degree group was more prone to sagittal imbalance than that of the group of FI < 10 degrees. Conclusion: the knee joint was flexed obviously in KOA patients, and the lumbar vertebrae of the patients with the spine and pelvic forward.FI less than 10o of the knee osteoarthritis would be compensated for mild knee flexion, and LL decreased. In severe patients, the knee flexion (FI10), the spine, the pelvis and the hip joint are involved in the sagittal plane, showing the spine forward, the pelvis forward and hip flexion. The decrease of the lumbar lordosis and the spine forward can accelerate the development or degrading of the chronic low back pain in these patients. The third part: Crowe IV type DDH patients with the spine to the pelvis and lower sagittal sagittal Objective: To explore the abnormal sagittal surface of Crowe IV of hip (DDH) and normal people and patients with primary osteoarthritis (hip osteoarthritis, HOA), and to explore the abnormal sagittal morphology of DDH patients and their clinical significance. The following parameters were collected from 40 normal people, 30 HOA patients and 16 patients with bilateral Crowe IV DDH, and the following parameters were measured: (1) pelvic sagittal plane parameters: pelvic incidence, PI, sacral slope, SS, pelvic inclination (pelvic tilt), sacral pelvis angle, Sacrum femoral angle (SFA), pelvis femur angle (pelvic femoral angle, PFA); (2) spinal sagittal plane parameters: spinal anterior tilt angle (spinal tilt, ST), lumbar anterior convex angle (lumbar), and sagittal plane parameters of the lower extremities: femoral tilting angle. Results: the reliability of each parameter in each group was compared. Results: the age of the three groups, the gender distribution difference was not statistically significant in.DDH group PI reliability (a=0.008) more than normal control (a=0.350) and HOA group (a=0.276) low.DDH SS (45.6 + 12.09), PT (16.7 + 8.81), PI (55.3 + 16.63), PFA (12.7 + 15.15), SPI (76.4 + 10.87), 14.3 + (14.3 +). 7.12) more than the HOA group, and the difference was statistically significant (P0.05); LL (37.3 + 15.87), ST (87.8 + 5.43) were similar to HOA group, and there was no statistical significance, but the difference was statistically significant compared with the normal control group (P0.05). Conclusion: DDH patients were more forward than HOA patients, leading to their spinal tilt, hip, and knee flexion in.DDH patients. These sagittal shapes need to be considered in the design of total hip arthroplasty.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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