成人脊柱畸形骨盆入射角变化与矢状面失平衡进展的相关性
The relationship between the change of pelvic incidence and progression of sagittal imbalance
胡宗杉 1李劫 1李东岳 1刘臻 1朱泽章 1邱勇1
作者信息
- 1. 南京大学医学院附属鼓楼医院骨科脊柱外科,南京 210008
- 折叠
摘要
目的 探讨成人脊柱畸形(adult spinal deformity,ASD)患者随访期间骨盆入射角(pelvic incidence,PI)的变化与矢状面失平衡进展的相关性.方法 回顾性分析2014年12月至2022年12月在南京鼓楼医院脊柱外科门诊治疗及随访ASD患者的病历资料,所有患者年龄均＞50岁,且随访时间至少2年.初诊及随访时均摄站立位全脊柱正侧位X线片,测量侧凸 Cobb角、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、局部后凸 Cobb角(regional ky-phosis,RK)、矢状面平衡(sagittal vertical axis,SVA)、Ti骨盆角(Ti pelvic angle,TPA)、PI、骨盆倾斜角(pelvic tilt,PT)及骶骨倾斜角(sacral slop,SS).使用组内相关系数(intraclass correlation coefficient,ICC)评估测量者间和测量者内的可靠性,ICC＞0.75表明测量的可重复性较好.采用Pearson相关性分析随访期间PI增加与其他影像学指标的相关性.结果 30例患者纳入研究,均为女性,年龄(61.93±6.20)岁(范围54～72岁),随访时间(37.47±8.57)个月(范围25～46个月).一致性检验结果显示PI测量的初诊观察者间ICC=0.917、末次随访时ICC=0.923,初诊观察者内ICC=0.913、末次随访时ICC=0.915.从初诊至末次随访 PI 由 44.47°±5.96° 增加至 52.07°±7.42°(t=13.375,P＜0.001),变化量为 7.60°±2.19°;PT(22.33°±5.77° 和28.07°±8.16°,t=4.268,P=0.001)、SVA[(40.03±13.34)mm和(64.37±27.06)mm,t=5.303,P＜0.001]、TPA(16.20°±5.02°和27.13°±6.45°,t=13.742,P＜0.001)、PI-LL(15.07°±13.92° 和 29.67°±13.54°,t=10.802,P＜0.001)增加,LL(29.40°±15.53°和22.40°±16.47°,t=4.814,P＜0.001)降低,脊柱矢状位形态呈逐渐失平衡趋势.Pearson相关性分析结果显示随访期间PT的变化(r=0.659,P=0.008)、TPA 的变化(r=0.629,P=0.012)、初诊 PI(r=0.560,P=0.030)及末次随访时 PI(r=0.746,P=0.001)与ASD患者随访期间PI的增加相关.结论 ASD患者随访期间PI呈增大趋势,PI的动态变化可能与进行性矢状面失平衡的发生存在相关性.
Abstract
Objective To clarify the characteristics of dynamic change of pelvic incidence(PI)in patients with adult spi-nal deformity in a longitudinal study,to explore the relationship of PI change and other sagittal parameters,and to investigate the role of PI change in the progression of global sagittal imbalance.Methods The patients with adult spinal deformity(ASD)who were followed up at our clinic from December 2014 to December 2022 were retrospectively reviewed.All patients were older than 50 years and had a minimum of 2-year follow-up.Full-spine frontal and lateral X-ray films were taken at pre-operation,post-opera-tion,and last follow-up.Radiographic parameters were measured,including Cobb angle,thoracic kyphosis(TK),lumbar lordosis(LL),regional kyphosis(RK),sagittal vertical axis(SVA),T1 pelvic angle(TPA),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS).Intraclass correlation coefficient(ICC)was used to evaluate intra-and inter-observers'reliability,of which ICC＞0.75 in-dicated excellent;0.5＜ICC≤0.75 indicated good;ICC≤0.5 indicated poor.Independent t-test,paired t-test and Pearson coefficient correlation were performed for statistical analysis.Results A total of 30 patients were included in this study with a mean age of 61.93±6.20 years(range 54-72 years).The mean follow-up duration was 37.47±8.57 months(range 25-46 months).ICC test showed an excellent intra-and inter-observer reliability of PI in ASD patients from baseline to last follow-up(inter-observer ICC:0.917 at baseline and 0.923 at last follow-up;intra-observer ICC:0.913 at baseline and 0.915 at last follow-up).From first-visit to the last follow-up,PI significantly increased from 44.47°±5.96° to 52.07°±7.42°(t=13.375,P＜0001),PT(22.33°±5.77° vs.28.07°±8.16°,t=4.268,P=0.001),SVA(40.03±13.34 mm vs.64.37±27.06 mm,t=5.303,P＜0.001),TPA(16.20°±5.02° vs.27.13°± 6.45°,t=13.742,P＜0.001)and PI-LL(15.07°±13.92° vs.29.67°±13.54°,t=10.802,P＜0.001)were significantly increased while LL was significantly decreased(29.40°±15.53° vs.22.40°±16.47°,t=4.814,P＜0.001)at last follow-up.Pearson correlation analy-sis showed that the change of PT(r=0.659,P=0.008),the change of TPA(r=0.629,P=0.012),pre-operation PI(r=0.560,P=0.030),and the last follow-up PI(r=0.746,P=0.001)were significantly correlated with last follow-up PI.Conclusion This study suggest-ed that PI could significantly increase during follow-up in ASD patients.The dynamic change of PI may be correlated with the dete-rioration of sagittal imbalance.
关键词
成年人/脊柱侧凸/随访研究/骨盆入射角/矢状面失平衡Key words
Adult/Scoliosis/Follow-up studies/Pelvic incidence/Sagittal imbalance引用本文复制引用
出版年
2024
NETL
NSTL
万方数据