摘要
目的探讨退变性胸腰椎后凸(DTLK)对脊柱矢状位的影响及胸腰段后凸继发性改变对矢状位平衡的影响。方法病例对照研究。回顾性纳入2018年1月至2021年12月50岁以上于北京大学人民医院确诊的DTLK[胸腰椎后凸角(TLK)>15°]128例(DTLK组)患者的临床资料。同时,纳入同时期单纯诊断腰椎管狭窄或椎间盘突出症且无胸腰段后凸(TLK=0°±15°)的手术患者73例为对照组。在全脊柱X线侧位片上获得以下参数:TLK、胸椎后凸角(TK)、腰椎前凸角(LL),矢状位平衡参数为矢状位偏移距离(SVA),此外通过双能X线吸收法(DXA)测定有无骨质疏松(OP),在MRI上测定L 5/S 1椎间盘信号分级(Pfirrmann分级)。基于年龄差异,用于评定脊柱平衡Lafage公式SVA=2×(年龄-55)+25作为阈值,针对胸腰椎后凸畸形患者,按平衡状态(SVA)分为平衡组和失衡组,明确该人群整体矢状位平衡的特点和影响因素,并分析平衡状态下脊柱各部位之间的相互作用。结果DTLK组TK(30.0°±13.5°比24.2°±7.4°)和TLK(26.6°±9.7°比6.0°±6.6°)大于对照组(P<0.01),LL小于对照组(34.4°±17.7°比44.2°±10.3°),差异均有统计学意义(均P<0.001)。DTLK组TK与TLK(r=0.234,P=0.008)和LL(r=0.539,P<0.001)存在相关性;LL减低与L 5/S 1间盘信号减低有正相关性(r=0.253,P=0.044)。LL丢失[RR=1.04(1.01~1.08)]和存在OP[RR=3.970(1.09~14.50)]是TLK患者易发生失衡的影响因素。DTLK平衡组患者TK的影响因素为LL(β=0.572,P<0.001)和年龄(β=0.351,P=0.045)。失衡组患者TK的正性影响因素为LL(β=0.209,P=0.015),LL对TK影响程度弱于平衡组。结论DTLK患者中LL丢失和OP更易导致失平衡及后凸进展,近端脊柱和腰椎协同维持该人群矢状位平衡。
Objective To explore the effect of degenerative thoracolumbar kyphosis(DTLK)on the sagittal alignment of the spine,as well as the impact on spinal parameters and imbalance secondary to thoracolumbar kyphosis.Methods A case-control study.A total of 128 DTLK patients who aged over 50 years[thoracolumbar kyphosis(TLK)>15°]treated in Peking University People′s Hospital from January 2018 to December 2021(DTLK group)were retrospectively included in this study.Other 73 contemporaneous patients with lumbar spinal stenosis or disc herniation without thoracolumbar kyphosis(TLK=0°±15°)were enrolled into the control group.The following parameters were obtained on spine X-ray:TLK,thoracic kyphosis(TK),lumbar lordosis(LL)and sagittal vertical axis(SVA).In addition,the osteoporosis(OP)was evaluated by dual-emission X-ray absorptiometry(DXA),and the L 5/S 1 disc signal grading(Pfirrmann grading)was evaluated on MRI.Based on the age,the Lafage formula SVA=2×(age-55)+25 was used to distinguish balance/imbalance,and the DTLK patients were divided into balanced and an imbalanced group,the characteristics and influencing factors of the loss of sagittal balance in this population were clarified,and the interaction among various parts of the spine under a state of balance was analyzed too.Results The TK(30.0°±13.5°vs 24.2°±7.4°)and TLK(26.6°±9.7°vs 6.0°±6.6°)in the DTLK group were both larger than those in control group while LL was smaller(34.4°±17.7°vs 44.2°±10.3°)(all P<0.001).TK was correlated to TLK(r=0.234,P=0.008)and LL(r=0.539,P<0.001)in DTLK group.LL loss was positively correlated to L 5/S 1 disc signal reduction(r=0.253,P=0.044).LL loss[RR=1.04(1.01-1.08)]and OP[RR=3.97(1.09,14.50)]were influencing factors for the occurrence of imbalance in DTLK patients.The influencing factors for TK in DTLK balance group were LL(β=0.572,P<0.001)and age(β=0.351,P=0.045).The positive influencing factor for TK in imbalanced group is LL(β=0.209,P=0.015),and the impact is weaker than balanced group.Conclusions Loss of LL and osteoporosis are more likely to cause imbalance and kyphosis in DTLK patients.In DTLK balance group,the proximal spine is regulated by lumbar spine,and the synergistic effect between the two parts maintains balance.
作者
格日勒
梁彦
徐帅
Ge Rile;Liang Yan;Xu Shuai(Trauma Medicine Center,Peking University People′s Hospital,Beijing 100044,China;Spinal Surgery,Peking University People′s Hospital,Beijing 100044,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2024年第13期1036-1042,共7页
National Medical Journal of China
基金
北京市自然科学基金(7232182)
北京大学人民医院研究与发展基金(RDL2022-52,RDY2021-12)
关键词
脊柱后凸
退变性胸腰椎后凸
脊柱矢状位序列
矢状位平衡
代偿机制
Kyphosis
Degenerative thoracolumbar kyphosis
Spinal sagittal alignment
Sagittal balance
Compensatory mechanisms
作者简介
通信作者:徐帅,Email:xushuairmyy@pku.edu.cn
