摘要
目的 探讨我国35岁以下青年腰椎间盘突出症患者的脊柱-骨盆矢状位序列的特征。方法 回顾性分析2017年1月~2019年1月我院骨科及疼痛科治疗74例35岁以下腰椎间盘突出症患者的临床影像学资料,描述患者的脊柱-骨盆矢状位参数,与我院既往无症状健康青年人的脊柱-骨盆矢状位序列的结果进行比较。结果 35岁以下青年腰椎间盘突出症患者较无症状健康青年人骨盆入射角(pelvic incidence, PI)、骨盆倾斜角(pelvic tilt,PT)显著增加(P=0.003,P=0.000),腰椎前凸角(lumbar lordosis, LL)、骶骨倾斜角(sacral slope,SS)显著减少(均P=0.000),胸椎后凸角(thoracic kyphosis, TK)无统计学差异(P=0.062),18例出现矢状位轴向距离(sagittal vertical axis, SVA)>5 cm。患者LL与TK、SS、脊柱骶骨角(spinal sacral angle, SSA)高度相关,与PT、SVA、骶-股距离(sacrofemoral distance, SFD)中度相关,与PI低度相关。SVA与SSA高度相关,与TK、LL、PT、SS、SFD中度相关。患者的胸腰段拐点约位于L2椎体下半部水平,腰椎前凸曲度的顶点约位于L4椎体的上半部水平。结论 35岁以下腰椎间盘突出症患者的脊柱-骨盆矢状位序列特征为胸椎和腰椎曲度丢失,骨盆后旋,全脊柱前倾,胸腰段拐点较低,参与腰椎前凸椎体较少。这种形态学特征改变了脊柱的力学结构。
Objective To explore the characteristics of sagittal alignment of spine-pelvis in lumbar disc herniation in Chinese patients under 35 years old.Methods The clinical imaging data of 74 lumbar disc herniation patients under 35 years old in our hospital from January 2017 to January 2019 were collected and retrospectively analyzed.The sagittal parameters of the spine and pelvis were measured and compared to our previous research of sagittal alignment in asymptomatic healthy young persons.Results As compared with asymptomatic healthy young persons,lumbar disc herniation patients under 35 years old showed a significant increase in pelvic incidence(PI)and pelvic tilt(PT)(P=0.003 and P=0.000)and a significant decrease in lumbar lordosis(LL)and sacral slope(SS)(all P=0.000).There was no statistically significant difference in thoracic kyphosis(TK)(P=0.062),and 18 cases showed sagittal vertical axis(SVA)>5 cm.The LL was highly correlated to TK,SS,and spinal sacral angle(SSA),moderately correlated to PT,SVA,and sacrofemoral distance(SFD),and weakly correlated to PI.The SVA was highly correlated to SSA and moderately correlated to TK,LL,PT,SS,and SFD.The inflection point of the thoracolumbar segment was located at the lower part of L 2 vertebra and the apex of lumbar lordosis was located at the upper part of L 4 vertebra.Conclusions The sagittal alignment of spine-pelvis in lumbar disc herniation patients under 35 years old is characterized as loss of curvature in the thoracic and lumbar vertebrae,pelvic supination,and total spinal forward tilt.The inflection point of the thoracolumbar segment is lower and less vertebrae are involved in lumbar lordosis.The sagittal alignment alters the mechanical structure of the spine.
作者
杨泽希
于淼
赵文奎
刘晓光
Yang Zexi;Yu Miao;Zhao Wenkui(Department of Orthopedics,Peking University Third Hospital,Beijing 100191,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2023年第4期272-278,共7页
Chinese Journal of Minimally Invasive Surgery
基金
北京大学第三医院临床重点项目(BYSYZD2019001)
北京大学第三医院临床重点项目(孵育项目)(BYSYZD2019017)
首都卫生发展科研专项(2020-2-4091)。
作者简介
通讯作者:刘晓光,E-mail:xgliudoctor@163.com。
