摘要
目的:分析后凸顶椎(kyphotic apical vertebra,KAV)位置对退变性脊柱后凸(degenerative kyphosis,DK)患者矢状面特征和生活质量的影响.方法:回顾分析2010年2月～2022年12月在南京鼓楼医院骨科住院治疗的68例DK患者的临床及影像学资料.男性8例,女性60例,年龄46～76岁(60.6±6.5岁).根据KAV位置不同将患者分为两组:KAV位于L1及以上的38例患者纳入G1组;KAV位于L1以下的30例患者纳入G2组.在术前站立位全脊柱侧位X线片上测量胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状面垂直轴(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、T1 骨盆角(T1-pelvic angle,TPA)、最大后凸 Cobb 角(global kyphosis,GK),计算PI-LL.采用国际脊柱侧凸研究学会(Scoliosis Research Society,SRS)-22量表、Oswestry功能障碍指数(Oswestry disability index,ODI)量表、疼痛视觉模拟量表(visual analog scale,VAS)评分以及 SF-36 量表评估患者生活质量.采用独立样本t检验比较两组患者的矢状面参数和生活质量问卷评分的差异,采用Pearson相关性分析研究矢状面参数与生活质量评分的相关性.结果:两组患者的年龄和性别比无显著性差异(P＞0.05),具有可比性.G1 组 GK、LL、TK、SVA、PI、PT、SS、TPA、PI-LL 分别为 61.3°±20.0°、26.9°±18.9°、32.3°±19.0°、53.5±48.1mm、40.4°±13.4°、24.8°±12.6°、17.0°±11.7°、23.0°±13.5°和 21.6°±15.6°,G2 组分别为 38.8°±16.0°、14.4°±13.7、10.8±9.8°、96.5±67.8mm、44.8°±16.2°、30.1°±10.8°、14.7°±11.5°、32.6°±14.5°和 33.8°±18.3°,G1 组的 GK、LL、TK 显著性大于 G2 组(P＜0.05),SVA、TPA、PI-LL 显著性小于 G2 组(P＜0.05);G1 组 VAS 评分、ODI、SF-36生理功能总分(physical component score,PCS)、SF-36 心理功能总分(mental component score,MCS)和 SRS-22评分(功能情况、疼痛、自我形象、心理状况和亚总分)分别为4.2±1.6分、(37.9±15.2)％、45.8±11.3、48.6±12.7、(17.6±4.6、18.6±4.3、17.7±4.5、17.8±4.9、71.7±9.3),G2 组分别为 5.8±1.7 分、(48.6±20.0)％、38.2±12.9、44.2±13.1、(15.6±4.5、16.0±3.6、16.6±4.9、17.1±4.3、65.4±11.1),G1 组 VAS 评分、ODI 显著性低于 G2 组(P＜0.05);G1组SRS-22量表亚总分、疼痛评分、SF-36 PCS评分显著性高于G2组(P＜0.05).Pearson相关性分析结果显示两组 SVA 与 VAS 评分和 ODI 均正相关(G1 组 r=0.437,P=0.006 和 r=0.356,P=0.028,G2 组 r=0.405,P=0.027 和r=0.408,P=0.025),与 SF-36 PCS 评分均负相关(G1 组 r=-0.365,P=0.024,G2 组r＝-0.410,P＝0.024);TPA 与VAS评分均正相关(G1组r=0.343,P=0.035,G2组r=0.369,P=0.045).G2组SVA与SRS-22量表亚总分负相关(r=-0.391,P=0.033),PI-LL与VAS评分正相关(r=0.390,P=0.033).结论:KAV位置会显著影响DK患者的骨盆-脊柱矢状面形态,KAV位于L1以下的患者SVA、TPA、PL-LL明显大于KAV位于L1及以上的患者,且与患者的生活质量下降显著性相关.
Abstract
Objectives:To analyze the impact of the kyphotic apical vertebra(KAV)position on sagittal plane characteristics and quality of life in patients with degenerative kyphosis(DK).Methods:A retrospective analy-sis was conducted on the clinical and imaging data of 68 DK patients hospitalized and treated in the Depart-ment of Orthopedic Surgery,Nanjing Drum Tower Hospital from February 2010 to December 2022.There were 8 males and 60 females,aged 46-76 years old(60.6±6.5 years).The patients were divided into two groups based on the position of the KAV:Group 1(G1)included 38 patients with the KAV at or above L1,and Group 2(G2)included 30 patients with the KAV below L1.The thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),T1-pelvic angle(TPA),and global kyphosis(GK)were measured on standing full-spine lateral X-rays before operation,and the value of PI-LL was calculated.Health related quality of life(HRQoL)was assessed using the Scoliosis Research So-ciety-22(SRS-22)questionnaire,Oswestry disability index(ODI),visual analog scale(VAS)score,and SF-36 questionnaire.Independent samples t-tests were used to compare sagittal plane parameters and HRQoL scores between the two groups.Pearson correlation analysis was employed to examine the relationship between sagit-tal plane parameters and HRQoL scores.Results:There was no significant difference in the age and sex ra-tios between the two groups(P＞0.05).The GK,LL,TK,SVA,PI,PT,SS,TPA,and PI-LL in G1 group were respectively 61.3°±20.0°,26.9°±18.9°,32.3°±19.0°,53.5±48.1mm,40.4°±13.4°,24.8°±12.6°,17.0°±11.7°,23.0°±13.5°,and 21.6°±15.6°,which in G2 group were 38.8°±16.0°,14.4°±13.7,10.8±9.8°,96.5±67.8mm,44.8°±16.2°,30.1°±10.8°,14.7°±11.5°,32.6°±14.5°,and 33.8°±18.3°.The GK,LL,and TK were significantly greater in G1 group than those in G2 group(P＜0.05),and SVA,TPA,and PI-LL were less in G1 group than those in G2 group(P＜0.05).The VAS score,ODI,SF-36 physical component score(PCS),SF-36 mental com-ponent score(MCS),SRS-22(function,pain,self-image,mental health,subtotal score)in G1 group were 4.2±1.6,(37.9±15.2)％,45.8±11.3,48.6±12.7,and(17.6±4.6,18.6±4.3,17.7±4.5,17.8±4.9,71.7±9.3),which were 5.8±1.7,(48.6±20.0)％,38.2±12.9,44.2±13.1,and(15.6±4.5,16.0±3.6,16.6±4.9,17.1±4.3,65.4±11.1)in G2 group.G1 group was lower in VAS score and ODI significantly(P＜0.05)and higher in SRS-22 subtotal score,SRS-22 pain domain score,and SF-36 PCS significantly(P＜0.05)than G2 group.Pearson correlation analysis showed that SVA was positively correlated with VAS and ODI in both groups(G1 group:r=0.437,P=0.006 and r=0.356,P=0.028;G2 group:r=0.405,P=0.027 and r=0.408,P=0.025),while negatively correlated with SF-36 PCS(G1 group:r=-0.365,P=0.024;G2 group:r=-0.410,P=0.024).TPA was positively correlated with VAS score in both groups(G1 group:r=0.343,P=0.035;G2 group:r=0.369,P=0.045).In G2 group,SVA neg-atively correlated with SRS-22 subtotal score(r=-0.391,P=0.033),and PI-LL was positively correlated with VAS score(r=0.390,P=0.033).Conclusions:The position of KAV affects the pelvic-spinal sagittal alignment obviously in DK patients,and the patients with KAV located below L1 level have significantly higher SVA,TPA,and PI-LL compared to the patients whose KAV located at or above L1 level,which is significantly associated with decreased quality of life.
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万方数据