|摘要||目的 分析胸椎及胸腰段角状后凸畸形对骨盆形态及序列的影响.方法 2002年5月至2010年6月收治的胸腰椎角状后凸患者32例,年龄13～56岁,平均29.6岁.详细记录患者病史以及病因.患者发生后凸畸形的年龄为1～17岁,平均6.1岁,陈旧结核性后凸畸形20例,先天性后凸畸形12例.全部患者接受后路截骨矫形手术.术前术后行全脊柱负重位X线侧位片检查(包括双侧髋关节),测量后凸畸形Cobb角、腰椎前凸(LL)、骨盆入射角(PI)、骶骨倾斜角(SS)、骨盆倾斜角(PT)以及脊柱的矢状位平衡(C7铅垂线与S1后上缘的水平距离,SVA).将测量结果与既往报道的正常值进行比较.比较中上胸椎后凸和下胸椎或胸腰段后凸的PI值.比较术前术后的各测量参数.分析PI的独立影响因素.结果 32例患者中,后凸角度平均为90.1°(31°～138°).术前PI平均为34.8°,SS为35.8°,PT为-0.7°,其中PI和PT明显小于对照组(P＜0.001).术后后凸角度改善至27.9°.术后PI平均为37.5°±9.4°,与术前比较差异无统计学意义(P＞0.05).12例患者后凸畸形位于中上胸椎(T1～8),20例位于下胸椎(T8以下)及胸腰段.两组相比,前者的PI值(40.5°)明显大于后者(31.5°,P＜0.05),前者SS(45.1°)亦明显大于后者(30.3°,P＜0.05).后凸角度和后凸部位是PI的独立影响因素,而年龄和LL对PI无影响.结论 胸腰椎角状后凸畸形若发生在儿童少年时期,将影响骨盆的形态发育(PI明显减小).后凸部位越低、后凸角度越大对骨盆形态的影响越大.手术可改变脊柱的序列,但骨盆的矢状位形态一旦形成将无法改变.早期治疗不仅可恢复脊柱的序列,亦有益于骨盆的正常形态的形成以及骨盆的正常矢状位序列.
Objective To analyze the impact of thoracic and thoracolumbar angular kyphosis on pelvic shape and sagittal alignment. Methods From May 2002 to June 2010, the sagittal spinopelvic parameters were analyzed in lateral standing radiographs of 32 patients (mean age 29.6 years ) with thoracolumbar angular kyphosis. The parameters included Cobb angle of kyphosis, lumbar lordosis ( LL),pelvic incidence ( PI ), sacrum slope ( SS), pelvic tilt ( PT ) and sagittal vertical axis ( SVA ). All pelvic parameters in the patients were compared with those reported in historical normal subjects. All patients were treated by using kyphotic correction and fusion. The preoperative and postoperative parameters were compared. The pelvic parameters were also compared between the patients with kyphotic apex located at T1-8 and those located at T9-12 and thoracolumbar junction. The linear regression analysis was used to investigate the independent factors of PI. Results The mean kyphosis was 90. 1 ° (31°-138°). The mean age of kyphosis occurrence was 6. 1 years. The mean PI, SS and PT were 34. 8° ,35.8° and -0. 7° respectively. The PI and PT were significantly smaller( P ＜ 0. 001 ) in the patients than those in normal subjects while the SS was similar. The kyphosis was improved to 27.9° post-operatively. There was no difference in PI values between preoperation and postoperation ( P ＞ 0. 05 ). The PI and SS in patients whose kyphosis located at thoracic spine(T1-8) were significantly higher than those at T9-L2. Instead of patients' age and LL, the preoperative Cobb angle of kyphosis and the levels where kyphosis located were two independent impact factors of PI. Conclusions The kyphosis occurred at childhood may influence pelvic shape and alignment significantly. The lower kyphotic apex located and the bigger kyphosis, the greater impact on the pelvic morphology. The surgery can improve the kyphosis, but can not change the sagittal pelvic morphology. Early treatment of thoracolumbar angular kyphosis is beneficial not only to reconstruction of spine alignment but also to the formation of sagittal pelvic morphology.|