青少年特发性脊柱侧凸Lenke1 B、C型患者的胸椎后凸状态对腰骶椎矢状面形态的影响The effect of thoracic kyphosis on sagittal balance of the lumbosacral spine in Lenke 1 B/C adolescent idiopathicscoliosis patients
陈涛;贾世青;刘昌生;黄善能;赖英静;邹焕文;
摘要(Abstract):
[目的]探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)Lenke1B、C患者的胸椎矢状面形态(thoracic kyphsis,TK)对腰骶椎矢状面形态的影响及意义。[方法]86例Lenke1B、C患者(男37例、女49例;平均年龄14.2岁)被纳入本研究,所有患者均摄站立位全脊柱正侧位X线片。根据胸椎后凸(TK)分为两组:A型TK<10°和B型10°≤TK≤40°。统计、测量以下影像学参数:腰椎前凸(LL)、上腰椎前凸、下腰椎前凸、主胸弯Cobb角、矢状面平衡(SVA)、骨盆投射角(PI)、骶骨倾斜角(SS)和骨盆倾斜角(PT)。[结果]A型的LL和上腰椎前凸小于B型的LL和上腰椎前凸(P<0.01)。相关性结果显示TK与LL(r=0.68,P=0.02)、上腰椎前凸(r=0.89,P=0.003)存在线性相关。此外,PT、SS及PI之间也存在线性相关。[结论]AIS Lenke1B、C患者的胸椎矢状面形态对腰椎前凸有明显影响,并通过上腰椎对整个腰椎形态产生影响。因此,对此类型患者在进行选择性胸椎融合时必须考虑这种相互影响,避免术后发生远端失代偿。
关键词(KeyWords): 青少年特发性脊柱侧凸;Lenke1B/C;胸椎后凸;腰骶椎矢状面
基金项目(Foundation):
作者(Author): 陈涛;贾世青;刘昌生;黄善能;赖英静;邹焕文;
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参考文献(References):
- [1]Antoniades SB,Hammerberg KW,De Wald RL.Sagittal plane configuration of the sacrum in spondylolisthesis[J].Spine(Phila Pa1976),2000,9:1085-1091.
- [2]Lee JH,Kim KT,Suk KS,et al.Analysis of spinopelvic parameters in lumbar degenerative kyphosis:correlation with spinal stenosis and spondylolisthesis[J].Spine(Phila Pa 1976),2010,24:1386-1391.
- [3]Debarge R,Demey G,Roussouly P.Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy[J].Eur Spine J,2010,1:65-70.
- [4]王渭君,王智伟,刘臻,等.青少年特发性脊柱侧凸脊柱-骨盆矢状面形态的性别差异[J].中国矫形外科杂志,2012,23:567-570.
- [5]郝定均,贺宝荣,吴起宁,等.前路和后路手术治疗胸腰段特发性脊柱侧凸的临床研究[J].中国矫形外科杂志,2009,13:980-982.
- [6]Chang KW,Cheng CW,Chen HC,et al.Closing-opening wedge osteotomy for the treatment of sagittal imbalance[J].Spine(Phila Pa1976),2008,13:1470-1477.
- [7]Legaye J,Beaupère G,Hecquet J,et al.Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves[J].Eur Spine J,1998,2:99-103.
- [8]Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J].Spine(Phila Pa 1976),2005,3:346-353.
- [9]Jackson RP,Hales C.Congruent spinopelvic alignment on standing lateral radiographs of adult volunteers[J].Spine(Phila Pa 1976),2000,21:2808-2815.
- [10]Gelb DE,Lenke LG,Bridwell KH,et al.An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers[J].Spine(Phila Pa 1976),1995,12:1352-1358.
- [11]邱勇,殷刚,曹兴兵,等.特发性胸椎侧凸患者的胸椎后凸状态对腰骶椎矢状面形态的影响[J].中华外科杂志,2008,16:1237-1240.
- [12]李危石,陈仲强,Wood KB.成人特发性脊柱侧凸患者脊柱-骨盆矢状位平衡分析[J].中国脊柱脊髓杂志,2011,3:207-211.
- [13]陈涛,贾世青,陈武,等.椎体间融合内固定治疗腰椎滑脱症:脊柱-骨盆参数的变化[J].中国组织工程研究,2013,4:576-581.
- [14]钱邦平,季明亮,邱勇,等.经椎弓根截骨对强直性脊柱炎胸腰椎后凸畸形脊柱-骨盆参数的影响[J].中华骨科杂志,2012,5:398-403.