脊柱—骨盆矢状面排列规律及新分型的研究

发布时间：2018-08-26 20:21

【摘要】：目的:测量志愿者人群脊柱全长X片脊柱-骨盆失状面参数,探讨其相关性,以腰椎前凸角(LL)及胸腰椎转折椎间隙(TLIP)为基础提出对成人脊柱-骨盆矢状面的新分型。方法:拍摄111例成人志愿者脊柱全长片。志愿者纳入标准:1、年龄20～60岁,2、无脊柱及下肢骨关节疾病史,3、无长期腰背痛史,4、X片无脊柱畸形,轻度椎体楔形变视为正常椎体变异。总计女56例,男55例。一般参数:年龄、体重、身高。X片测量参数包括:胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、骶骨倾斜角(SS)、骨盆倾斜角(PT)、骨盆指数(PI)、矢状面垂轴(SVA)、脊柱骶骨角(SSA)、各椎体间终板夹角、胸腰椎转折椎间隙(TLIP,胸椎后凸和腰椎前凸交界,椎体间终板夹角绝对值最接近0°的椎间隙)。统计学描述分析各测量参数,Pearson correlation coefficient检验各参数间相关性。根据LL、TLIP将成人脊柱-骨盆矢状面分为3型,Ⅰ型至Ⅲ型组间各参数分别进行多重比较。结果:年龄 37.22±10.77 岁(20～60 岁),身高 164.68±7.72cm(144～186cm),体重 60.83±10.83Kg(45～99 Kg)。TK36.03±7.34°(17.8～56.5°),TLK 6.40±7.43°(-12.85～23.43。),LL-48.75±10.03°(-68.6～-21.2°),SS 33.57±7.64°(14.07～52.18°),PT 11.18±6.59°(-3.93～31.75°),PI 44.75±9.01°(24.69°～70.52),SVA-2.66±22.79mm(-65.81～44.73mm),SSA 127.32±8.98°(106.25～153.92°),各椎体间终板夹角 L5S1-11.82±4.23°(-23.4～-2.3°),L4L5-12.13±3.01°(-18.51～-5.53°),L3/L4-6.46±2.33°(-13～0°),L2L3-3.51±2.18°(-9.92～1.29°),L1L2-1.53±1.97°(-7.94～2.51°),T12L10.25±1.59°(-5.51～4.81°),T11T12 1.64±1.44°(-3.83～5.59°),T10T112.2±0.99°(-2.3～5.56°),TLIP 为 L3/4 1 例、L2/3 18 例、L1/2 13 例、T12/L1 62 例、T11/12 17例。Pearson correlation coefficient检验仅LL与其它参数均有显著相关性,LL 与 TK、PI、SS、SSA 呈负相关,r 分别为-0.387、-0.536、-0.858、-0.801(P0.01),与 TLK、SVA、PT 呈正相关,r 分别为 0.319、0.296、0.262(P0.01)。根据LL、TLIP将成人脊柱-骨盆矢状面分为3型,Ⅰ型:LL-40°,TLIP为 L2/3 以下;Ⅱ型:-60°LL-40°,TLIP 为 L1/2 或 T12/L1;Ⅲ型:LL-60°,TLIP为T11/12以上。入选志愿者均可纳入分型:Ⅰ型19例,Ⅱ型75例,Ⅲ型17例。分型间Multiple Comparisons LSD多重比较示LL、SS、SSA、PI组间两两比较P值均0.05。结论:成人脊柱-骨盆排列规律为腰椎前凸角小,常数PI小,胸腰段后凸,胸椎后凸小与胸腰段形成一长节段后凸,骶骨后倾,骶骨后上角向后远离股骨头,骨盆开口水平,躯干前倾,脊柱趋向正向失衡,反之亦然。LL在脊柱矢状面平衡中占有核心地位。成人脊柱-骨盆矢状面根据LL和TLIP可分为三型,该分型能较好反映脊柱骨盆矢状面排列的差异与平衡。
[Abstract]:Objective: to measure the parameters of spinal column-pelvis loss plane in a volunteer population and to study its correlation. A new type of adult spine-pelvic sagittal plane was proposed based on lumbar kyphosis angle (LL) and thoracolumbar vertebrae intervertebral space (TLIP). Methods: a total length film of the spinal column was taken from 111 adult volunteers. The inclusion criteria were 1: 1, 20 to 60 years of age, with no history of spine and lower extremity osteoarthropathy, no history of long-term low back pain, no spinal deformity, and mild vertebral wedge degeneration as normal vertebral body variation. There were 56 women and 55 men. General parameters: age, weight, Height. X ray measurement parameters include: thoracic kyphosis angle (TK), thoracolumbar segment kyphosis angle (TLK), lumbar kyphosis angle (LL), sacral angle obliquity angle of (SS), pelvis obliquity angle (PT), pelvic index (PI), sagittal plane (SVA), spine sacrum angle (SSA), interbody endplate angle. Thoracolumbar intervertebral space (TLIP, thoracic kyphosis and lumbar kyphosis, the intervertebral interbody endplate angle is closest to the intervertebral space of 0 掳). The correlation between the parameters was analyzed by Pearson correlation coefficient test. According to LL,TLIP, the sagittal plane of adult spine and pelvis was divided into 3 types. 缁撴灉:骞撮緞 37.22卤10.77 宀，

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