60岁以上脊柱畸形患者脊柱-骨盆矢状面参数与生活质量的相关性分析

发布时间：2018-08-28 16:34

【摘要】：目的 :探讨60岁以上脊柱畸形患者脊柱-骨盆矢状面参数与生活质量的相关性。方法 :2014年3月~2016年5月60岁以上存在脊柱侧凸20°、矢状面躯干偏移(sagittal vertical axis,SVA)5cm或骨盆倾斜角(pelvic tilt,PT)25°的脊柱畸形患者共43例被纳入研究,男7例,女36例,年龄64.0±3.5岁(60.0~73.0岁),其中退变性脊柱侧凸12例,退变性脊柱后凸畸形7例,退变性脊柱侧后凸畸形12例,特发性脊柱侧凸6例,特发性脊柱侧后凸畸形1例,陈旧性脊柱骨折伴后凸畸形5例。使用Scoliosis Research Society(SRS)-22量表、Oswestry功能障碍指数(Oswestry disability index,ODI)量表以及背部和下肢疼痛视觉模拟评分(the visual analog scale,VAS)评估患者的生活质量;在站立位全脊柱侧位X线片上测量脊柱-骨盆矢状面参数,包括SVA、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、PT、骶骨倾斜角(sacral slope,SS)和T1骨盆角(T1 pelvic angle,TPA)。计算PI减LL,即PI-LL值。采用Pearson相关性检验分析脊柱-骨盆矢状面参数与生活质量的相关性。结果:SRS-22量表中功能状态、疼痛、自我形象、心理状况及亚总分分别为13.4±2.1分、17.3±2.7分、13.2±3.0分、15.7±11.8分及59.6±5.6分;ODI、背部及下肢疼痛VAS评分分别为(46.8±17.8)%、5.7±2.6分和3.9±3.0分。SVA、TK、LL、PI、PT、SS、TPA和PI-LL分别为6.5±6.2cm、12.7°±15.8°、-16.9°±17.2°、49.0°±12.3°、30.2°±11.6°、18.8°±10.6°、28.8°±14.4°和32.1°±17.8°。SVA和TPA与SRS-22量表中功能状况、疼痛、自我形象、SRS-22亚总分、ODI及背部疼痛VAS评分显著相关(r=-0.386、-0.375、-0.361、-0.410、0.445、0.389,P0.05;r=-0.403、-0.426、-0.466、-0.425、0.512、0.465,P0.05);LL、PT、PI-LL与ODI及背部疼痛VAS评分显著相关(r=0.368、0.367,P0.05;r=0.376、0.341,P0.05;r=0.401、0.395,P0.05);TK、PI和SS与生活质量各量表评分均无关(P0.05)。结论 :在60岁以上脊柱畸形患者中,TPA和SVA增大会增加患者功能障碍、腰背部疼痛程度并降低患者自我形象;LL减小、PT和PI-LL增大会加重患者腰背部疼痛程度。TPA能同时反映脊柱和骨盆矢状面状态,和生活质量相关性最强。
[Abstract]:Objective: to investigate the correlation between the sagittal plane parameters of spine and pelvis and quality of life in patients with spinal deformity over 60 years old. Methods: from March 2014 to May 2016, 43 patients (7 males and 36 females) with scoliosis 20 掳, sagittal trunk offset (sagittal vertical axis,SVA) 5cm or pelvic tilt angle (pelvic tilt,PT) 25 掳were included in the study. The age was 64.0 卤3.5 years (60.073.0 years), including 12 degenerative scoliosis, 7 degenerative scoliosis, 12 degenerative scoliosis, 6 idiopathic scoliosis and 1 idiopathic scoliosis. 5 cases of old spinal fracture with kyphosis. The quality of life (QOL) was evaluated by Scoliosis Research Society (SRS) 22 (Oswestry disability index,ODI) and visual analogue score (the visual analog scale,VAS) of back and lower limb pain, and the sagittal parameters of spine and pelvis were measured on the standing position of the lateral spine. SVA, included thoracic kyphoid angle (thoracic kyphosis,TK), lumbar lordosis angle (lumbar lordosis,LL), pelvic incident angle (pelvic incidence,PI) PTT, sacral obliquity angle (sacral slope,SS) and T1 pelvic angle (T1 pelvic angle,TPA). Calculate PI minus LL, or PI-LL value. The correlation between sagittal parameters of spine and pelvis and quality of life was analyzed by Pearson correlation test. Results functional state, pain, self-image, 蹇冪悊鐘跺喌鍙婁簹鎬诲垎鍒嗗埆涓，

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