成人脊柱-骨盆矢状面参数及排列规律研究

成人脊柱-骨盆矢状面参数及排列规律研究尹刚辉1、朱玲湘2、陈瑞松1、陆明1、吕志德1、闫慧博1、金大地1

1、南方医科大学第三附属医院骨科

2、南方医科大学生物统计系

【摘要】目的：通过测量成人志愿者脊柱-骨盆矢状面参数及相关性研究，探讨成人脊柱-骨盆的矢状面排列规律。方法：拍摄成人志愿者脊柱全长片，测量脊柱-骨盆矢状面参数值，包括：胸椎后凸角（TK thoracic kyphosis）、胸腰段后凸角（TLK thoracolumbar kyphosis）、腰椎前凸角（LL lumbar lordosis）、骶骨倾斜角（SS sacral slope）、骨盆倾斜角（PT pelvic tilt）、骨盆指数（PI pelvic incidence）、各椎体间终板夹角（Intervertebral endplate angle）、矢状面垂轴（SVA sagittal vertical axis）、脊柱骶骨角（SSA spino-sacral angle）。统计分析各参数，Pearson correlation coefficient检验各参数间相关性。结果：总计入选111例，女56例，男55例，年龄37.22±10.77岁，身高164.68±7.72cm，体重60.83±10.83Kg。LL-48.75±10.03°，TK36.03±7.34°，TLK6.40±7.43°，PT 11.18±6.59°，SS 33.57±7.64°，PI44.75±9.01°，SAV-2.66±22.79mm，SSA 127.32±8.98°。LL与所有参数均有显著相关性（P＜0.01），其中LL与TK、PI、SS、SSA负相关（r=），与TLK、SAV、PT正相关（r=）。SSA除TK外与其它参数均有显著相关性（P ＜0.01）。结论：成人脊柱-骨盆排列规律为腰椎前凸角小，常数PI小，胸腰段后凸、胸椎后凸小与胸腰段形成一长节段后凸，骶骨后倾，骶骨后上角向后远离股骨头，骨盆开口水平，躯干前倾，脊柱趋向正向失衡，反之亦然。LL在脊柱矢状面平衡中占有核心地位。LL与SSA对于评估脊柱-骨盆矢状面平衡更具临床参考价值。

【关键词】脊柱；骨盆；矢状面平衡；正常值；

Spino-Pelvic Sagittal Alignment in Adult Volunteers

YIN Gang-hui1，ZHU Lin-xiang2，CHEN Rui-song1，LV Zhi-de1，LU Ming1，JIN Da-di1

1.Department of orthopaedics of the third affiliated hospital , SouthenMedicalUniversity

2.Department of Statistics of SouthenMedicalUniversity

Guangzhou 510630,China

【abstract】Objective A radiographic evaluation of spino-pelvic sagittal parameters in Chinese adult volunteers to determine the correlation between the parameters.Methods Whole

spine,standing lateral radiographs of 111Chinese adult volunteers were taken. Radiographic measurementswere made usingthe Cobb technique and pelvic radius technique.The spinal and

pelvic parametersIncluded:TK (thoracic kyphosis), TLK (thoracolumbar kyphosis), LL (lumbar lordosis), SS(sacral slope), PT (pelvic tilt), PI( pelvic incidence), Intervertebral endplate Angle, SV A (sagittal vertical axis), SSA(spino-sacral Angle), HA-S1 sacral translation distance、PA （pelvic angle）、PR-S1 pelvic morphology、PR-T12 total lumbopelviclordosis、Segment lumbopelviclordosis.Alldataand correlations between the parameters were statisticalanalyzed.Results The means±SD as follow:age37.22±10.77 years, height

164.68±7.72cm, weight 60.83±10.83Kg, LL -48.75±10.03°, TK 36.03 ±7.34°, TLK 6.40±7.43°, PT 11.18±6.59°, SS 33.57±7.64°, PI 44.75±9.01°, PA 16.38±6.23°, PR-S1 -40.05±8.35°,HA-S1 33.93±12.2mm, SAV -2.66±22.79mm, SSA 127.32±8.98°.Only LL hadsignificantstatistical correlation with allthe other parameters.Negative correlation presented between LL and TK, PI, SS, PR-S1, SSA (P < 0.01). Positive correlationpresented between LL and TLK, HA-S1, SA V,

PR-T12, PA, PT (P < 0.01). SSA had significantstatistical correlation with all the other parametersbut TK (P < 0.01).High significantstatisticalpositive Pearson correlation coefficient presented between PI and PR-S1(r=0.994,P<0.01),as PT and

PA(r=0.985,P<0.01)Conclusion TheChinese adults spino-pelvic sagittal parameters’ data base was built.Thesagittal alignment from thoracic to pelvis presented significant correlation,through the statistical correlation analysis. LL and SSA were more practical in evaluating the spino-pelvis sagittal balance.Wesuggest to combine PI with PR-S1to establish a new spino-pelvic sagittal balance evaluation system.

【key words】Spine; Pelvic; Sagittal balance; Normal value

矢状面平衡的脊柱以最小能耗维持躯干稳定[1]。Dubousset用经济圆锥（Conus of Economy）来阐述脊柱矢状面平衡对于维持躯干稳定及姿势中的重要性，躯体失衡将加大维持姿势的能耗，直至无法维持直立[2]。脊柱-骨盆矢状面平衡在诊治脊柱畸形、腰椎滑脱、预防和治疗“平背综合征”中越来越受到临床及科研的关注。目前国外有报导脊柱-骨盆矢状面参数“正常值”及参数间相关性的文献，但国内尚缺乏成人脊柱-骨盆矢状面参数的文献，临床及科研中也缺乏矢状面参数“正常值”来进行比较分析[3]。我院2011年7月至8月拍摄111例国人志愿者脊柱全长片，测量C7至骨盆的脊柱-骨盆矢状面参数，并统计分析其相关性，现报道如下。

1资料与方法

1.1 一般资料

1.1.1志愿者来源及纳入标准

志愿者来源于本医院医生、护士、学生及体检中心体检人群，纳入标准：1、年龄20~60岁，2、无脊柱及下肢骨关节疾病史，3、无长期腰背痛史，4、X片无脊柱畸形，轻度椎体楔形变视为正常椎体变异。志愿者拍摄均签署知情同意书。参试者共计223例。

1.1.2拍摄方法