骨盆入射角对成人腰骶部峡部裂滑脱程度和矢状面形态的影响
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摘要
目的 :探讨成人腰骶部低度峡部裂性滑脱患者骨盆入射角(pelvic incidence,PI)分布情况及其对滑脱程度和脊柱骨盆矢状面形态的影响。方法:回顾性分析2012年1月～2017年8月在我院就诊的Meyerding分型Ⅰ～Ⅱ度腰骶部峡部裂性滑脱患者的临床资料。按照SDSG滑脱分型中PI分组标准分为低PI组(PI<45°)、中PI组(45°～60°)和高PI组(PI>60°)。测量的参数包括滑脱率、椎间隙高度、骨盆入射角、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、上腰椎前凸角、下腰椎前凸角、胸椎后凸角、矢状面垂直距离(sagittal vertical axis,SVA),同时计算腰椎前凸分布指数(lordosis distribution index,LDI=下腰椎前凸角/LL)、PT/PI。采用单样本K-S检验本组患者PI分布情况,采用单因素方差分析比较三组之间影像学参数的差异,采用Pearson相关性分析PI与其他参数的关系。结果:共153例患者纳入本研究,其中男50例、女103例,年龄51.7±10.4岁(31～71岁)。腰骶部峡部裂性滑脱患者PI呈正态分布(P=0.20),均值为59.9°±10.5°,低、中和高PI组分别有12(8%)、67(44%)和74(48%)例。低PI组滑脱率明显低于中PI组和高PI组(P<0.001),而高PI组L5/S1椎间隙高度明显低于其余两组(P<0.05)。低PI组PT、SS、PT/PI、LL、上腰椎前凸角、下腰椎前凸角均显著低于中PI组和高PI组(P<0.01);而LDI明显高于中PI组和高PI组(P=0.001)。高PI组SVA明显高于低PI组和中PI组(P<0.05)。Pearson相关性分析发现PI与滑脱率、PT、SS、PT/PI、LL、上腰椎前凸角、下腰椎前凸角、SVA成正相关,与LDI呈负相关(P<0.05)。结论:成人腰骶部低度峡部裂性滑脱患者PI呈正态分布,低PI患者滑脱程度较轻,高PI患者腰骶部椎间隙塌陷、滑脱程度重,骨盆后旋导致下腰椎前凸丢失。
Objectives: To evaluate the distribution of pelvic incidence(PI) and its influence on sagittal alignment of lumbosacral isthmic spondylolisthesis(IS). Methods: The consecutive lumbosacral IS patients(Meyerding grade Ⅰ or Ⅱ) between January 2012 and August 2017 were retrospectively reviewed. According to SDSG slippage PI grouping standard, the enrolled patients were divided into the low PI group(PI<45°), the normal PI group(45°-60°) and the high PI group(PI >60°). Parameters were measured, including slip percentage, disc height, pelvic incidence, pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), lower lumbar lordosis, upper lumbar lordosis, thoracic kyphosis, sagittal vertical axis(SVA). Meanwhile, lordosis distribution index(LDI=lower lumbar lordosis/LL) and PT/PI were calculated. The above parameters were compared among groups. Results: Totally, 153 patients(50 males and 103 females) were enrolled, with a mean age of 51.7 ±10.4 years(range, 31-71 years). The PI of cohort had a normal distribution(P =0.20) and the mean PI was59.9°±10.5°. There were 12(8%), 67(44%) and 74(48%) patients assigned in the low PI, normal PI and high PI group respectively. The slip degree of low PI group was significantly lower than that of normal PI group and high PI group(P<0.001). The L5/S1 disc height of high PI group was higher than that of the other two groups(P<0.05). PI, PT, SS, PT/PI, LL, lower lumbar lordosis, upper lumbar lordosis in low PI group were statistically lower than that of normal PI group and high PI group(P<0.01). However, LDI of low PI group was significantly higher than that of normal PI and high PI group(P=0.001). Meanwile, SVA of high PI group was higher than that of the other two groups(P <0.05). Positive correlations were found between PI and slip percentage, PT, SS, PT/PI, LL, upper lumbar lordosis, lower lumbar lordosis and SVA, and negative correlations were noted between PI and LDI(P<0.05). Conclusions: The PI of lumbarsacral low-grade IS was normally distributed. The slip degree of lumbarsacral isthmic spondylisthesis is positively correlated with PI.Patients with low PI have mild degree of spondylolisthesis. Patients with high PI have severe degree of spondylolisthesis and remarkable disc collapse, as well as pelvic retroversion.
Objectives: To evaluate the distribution of pelvic incidence(PI) and its influence on sagittal alignment of lumbosacral isthmic spondylolisthesis(IS). Methods: The consecutive lumbosacral IS patients(Meyerding grade Ⅰ or Ⅱ) between January 2012 and August 2017 were retrospectively reviewed. According to SDSG slippage PI grouping standard, the enrolled patients were divided into the low PI group(PI<45°), the normal PI group(45°-60°) and the high PI group(PI >60°). Parameters were measured, including slip percentage, disc height, pelvic incidence, pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), lower lumbar lordosis, upper lumbar lordosis, thoracic kyphosis, sagittal vertical axis(SVA). Meanwhile, lordosis distribution index(LDI=lower lumbar lordosis/LL) and PT/PI were calculated. The above parameters were compared among groups. Results: Totally, 153 patients(50 males and 103 females) were enrolled, with a mean age of 51.7 ±10.4 years(range, 31-71 years). The PI of cohort had a normal distribution(P =0.20) and the mean PI was59.9°±10.5°. There were 12(8%), 67(44%) and 74(48%) patients assigned in the low PI, normal PI and high PI group respectively. The slip degree of low PI group was significantly lower than that of normal PI group and high PI group(P<0.001). The L5/S1 disc height of high PI group was higher than that of the other two groups(P<0.05). PI, PT, SS, PT/PI, LL, lower lumbar lordosis, upper lumbar lordosis in low PI group were statistically lower than that of normal PI group and high PI group(P<0.01). However, LDI of low PI group was significantly higher than that of normal PI and high PI group(P=0.001). Meanwile, SVA of high PI group was higher than that of the other two groups(P <0.05). Positive correlations were found between PI and slip percentage, PT, SS, PT/PI, LL, upper lumbar lordosis, lower lumbar lordosis and SVA, and negative correlations were noted between PI and LDI(P<0.05). Conclusions: The PI of lumbarsacral low-grade IS was normally distributed. The slip degree of lumbarsacral isthmic spondylisthesis is positively correlated with PI.Patients with low PI have mild degree of spondylolisthesis. Patients with high PI have severe degree of spondylolisthesis and remarkable disc collapse, as well as pelvic retroversion.
引文
1.Roussouly P,Gollogly S,Berthonnaud E.The sagittal alignment of the spine and pelvis in the presence of L5-S1 isthmiclysis and low-grade spondylolisthesis[J].Spine,2006,31(21):2484-2490.
2.Fredrickson B,Baker D,Mcholick W,et al.The natural history of spondylolysis and spondylolisthesis[J].J Bone Joint Surg Am,1984,66(5):699-707.
3.Ferrero E,Ould-Slimane M,Gille O,et al.Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis[J].Eur Spine J,2015,24(6):1219-1227.
4.Ońska-Sudo KJ,Maciejczak A.Relationship between the spino-pelvic parameters and the slip grade in isthmic spondylolisthesis[J].Neurol Neurochir Pol,2015,49(6):381-388.
5.Tebet MA.Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis[J].Rev Bras Ortop,2014,49(1):3-12.
6.Oh YM,Choi HY,Eun JP.The comparison of sagittal spinopelvic parameters between young adult patients with L5spondylolysis and age-matched control group[J].J Korean Neurosurg Soc,2013,54(3):207-210.
7.Zhu Z,Xu L,Zhu F,et al.Sagittal Alignment of Spine and Pelvis in Asymptomatic Adults[J].Spine,2014,39(1):1-6.
8.Legaye J,Duval-Beaupere G,Hecquet J,et al.Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves[J].Eur Spine J,1998,7(2):99-103.
9.Labelle H,Roussouly P,Berthonnaud E R,et al.Spondylolisthesis,pelvic incidence,and spinopelvic balance:a correlation study[J].Spine,2004,28(19):2049-2054.
10.Yin J,Peng BG,Li YC,et al.Differences of sagittal lumbosacral parameters between patients with lumbar spondylolysis and normal adults[J].Chin Med J(Engl),2016,129(10):1166-1170.
11.何守玉,朱锋,邱勇,等.成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义[J].中国脊柱脊髓杂志,2014,24(2):109-115.
12.Labelle H,Mac-Thiong J,Roussouly P.Spino-pelvic sagittal balance of spondylolisthesis:a review and classification[J].Euro Spine J,2011,20(5):641-646.
13.Yilgor C,Sogunmez N,Yavuz Y,et al.Relative lumbar lordosis and lordosis distribution index:individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis[J].Neurosurg Focus,2017,43(6):E5.
14.Bao H,Yan P,Zhu W,et al.Validation and reliability analysis of the Spinal Deformity Study Group Classification for L5-S1 lumbar spondylolisthesis[J].Spine,2015,40(21):1150-1154.
15.Sterba M,Arnoux PJ,Labelle H,et al.Biomechanical analysis of spino-pelvic postural configurations in spondylolysis subjected to various sport-related dynamic loading conditions[J].Eur Spine J,2018,doi:10.1007/s00586-018-5667-0.[Epub ahead of print].
16.Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J].Spine,2005,30(3):346-353.
17.Ramakrishna VAS,Chamoli U,Viglione LL,et al.Mild(not severe)disc degeneration is implicated in the progression of bilateral L5 spondylolysis to spondylolisthesis[J].BMC Musculoskeletal Disorders,2018,19(1):1-11.
18.Luk KDK,Chow DHK,Holmes A.Vertical instability in spondylolisthesis:a traction radiographic assessment technique and the principle of management[J].Spine,2003,28(8):819-827.
19.许勇,郭昭庆,云才.合并椎间盘突出的退变性腰椎滑脱椎间盘形态改变及其意义[J].中国脊柱脊髓杂志,2012,22(5):398-402.
20.Been E,Li L,Hunter DJ,et al.Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis:pilot study[J].Eur Spine J,2011,20(7):1159-1165.
21.Roberts S,Evans H,Trivedi J,et al.Histology and pathology of the human intervertebral disc[J].J Bone Joint Surg Am,2006,88(Suppl 2):10-14.
22.Colombini A,Lombardi G,Corsi MM,et al.Pathophysiology of the human intervertebral disc[J].Int J Biochem Cell Biol,2008,40(5):837-842.
23.张奎渤,辉刘,王建儒,等.L5轻度峡部裂型滑脱患者脊柱-骨盆矢状面参数与椎间盘退变的关系[J].中国矫形外科杂志,2015,23(7):605-609.
24.Roussouly P,Pinheiro-Franco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology[J].Eur Spine J,2011,20(Suppl 5):609-618.
25.Pourtaheri S,Sharma A,Savage J,et al.Pelvic retroversion:a compensatory mechanism for lumbar stenosis[J].J Neurosurg Spine,2017,27(2):137-144.
26.Liu H,Li S,Zheng Z,et al.Pelvic retroversion is the key protective mechanism of L4-5 degenerative spondylolisthesis[J].Eur Spine J,2015,24(6):1204-1211.
27.Zhu F,Bao H,Liu Z,et al.Analysis of L5 incidence in normal population use of L5 incidence as a guide in reconstruction of lumbosacral alignment[J].Spine,2014,39(2):140-146.
28.Tempel ZJ,Gandhoke GS,Bolinger BD,et al.The influence of pelvic incidence and lumbar lordosis mismatch on development of symptomatic adjacent level disease following single-level transforaminal lumbar interbody fusion[J].Neurosurgery,2017,80(6):880-886.
29.Harroud A,Labelle H,Joncas J,et al.Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis[J].Eur Spine J,2013,22(4):849-856.
2.Fredrickson B,Baker D,Mcholick W,et al.The natural history of spondylolysis and spondylolisthesis[J].J Bone Joint Surg Am,1984,66(5):699-707.
3.Ferrero E,Ould-Slimane M,Gille O,et al.Sagittal spinopelvic alignment in 654 degenerative spondylolisthesis[J].Eur Spine J,2015,24(6):1219-1227.
4.Ońska-Sudo KJ,Maciejczak A.Relationship between the spino-pelvic parameters and the slip grade in isthmic spondylolisthesis[J].Neurol Neurochir Pol,2015,49(6):381-388.
5.Tebet MA.Current concepts on the sagittal balance and classification of spondylolysis and spondylolisthesis[J].Rev Bras Ortop,2014,49(1):3-12.
6.Oh YM,Choi HY,Eun JP.The comparison of sagittal spinopelvic parameters between young adult patients with L5spondylolysis and age-matched control group[J].J Korean Neurosurg Soc,2013,54(3):207-210.
7.Zhu Z,Xu L,Zhu F,et al.Sagittal Alignment of Spine and Pelvis in Asymptomatic Adults[J].Spine,2014,39(1):1-6.
8.Legaye J,Duval-Beaupere G,Hecquet J,et al.Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves[J].Eur Spine J,1998,7(2):99-103.
9.Labelle H,Roussouly P,Berthonnaud E R,et al.Spondylolisthesis,pelvic incidence,and spinopelvic balance:a correlation study[J].Spine,2004,28(19):2049-2054.
10.Yin J,Peng BG,Li YC,et al.Differences of sagittal lumbosacral parameters between patients with lumbar spondylolysis and normal adults[J].Chin Med J(Engl),2016,129(10):1166-1170.
11.何守玉,朱锋,邱勇,等.成人峡部裂性腰椎滑脱患者脊柱-骨盆矢状面参数变化及其临床意义[J].中国脊柱脊髓杂志,2014,24(2):109-115.
12.Labelle H,Mac-Thiong J,Roussouly P.Spino-pelvic sagittal balance of spondylolisthesis:a review and classification[J].Euro Spine J,2011,20(5):641-646.
13.Yilgor C,Sogunmez N,Yavuz Y,et al.Relative lumbar lordosis and lordosis distribution index:individualized pelvic incidence-based proportional parameters that quantify lumbar lordosis more precisely than the concept of pelvic incidence minus lumbar lordosis[J].Neurosurg Focus,2017,43(6):E5.
14.Bao H,Yan P,Zhu W,et al.Validation and reliability analysis of the Spinal Deformity Study Group Classification for L5-S1 lumbar spondylolisthesis[J].Spine,2015,40(21):1150-1154.
15.Sterba M,Arnoux PJ,Labelle H,et al.Biomechanical analysis of spino-pelvic postural configurations in spondylolysis subjected to various sport-related dynamic loading conditions[J].Eur Spine J,2018,doi:10.1007/s00586-018-5667-0.[Epub ahead of print].
16.Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J].Spine,2005,30(3):346-353.
17.Ramakrishna VAS,Chamoli U,Viglione LL,et al.Mild(not severe)disc degeneration is implicated in the progression of bilateral L5 spondylolysis to spondylolisthesis[J].BMC Musculoskeletal Disorders,2018,19(1):1-11.
18.Luk KDK,Chow DHK,Holmes A.Vertical instability in spondylolisthesis:a traction radiographic assessment technique and the principle of management[J].Spine,2003,28(8):819-827.
19.许勇,郭昭庆,云才.合并椎间盘突出的退变性腰椎滑脱椎间盘形态改变及其意义[J].中国脊柱脊髓杂志,2012,22(5):398-402.
20.Been E,Li L,Hunter DJ,et al.Geometry of the vertebral bodies and the intervertebral discs in lumbar segments adjacent to spondylolysis and spondylolisthesis:pilot study[J].Eur Spine J,2011,20(7):1159-1165.
21.Roberts S,Evans H,Trivedi J,et al.Histology and pathology of the human intervertebral disc[J].J Bone Joint Surg Am,2006,88(Suppl 2):10-14.
22.Colombini A,Lombardi G,Corsi MM,et al.Pathophysiology of the human intervertebral disc[J].Int J Biochem Cell Biol,2008,40(5):837-842.
23.张奎渤,辉刘,王建儒,等.L5轻度峡部裂型滑脱患者脊柱-骨盆矢状面参数与椎间盘退变的关系[J].中国矫形外科杂志,2015,23(7):605-609.
24.Roussouly P,Pinheiro-Franco JL.Biomechanical analysis of the spino-pelvic organization and adaptation in pathology[J].Eur Spine J,2011,20(Suppl 5):609-618.
25.Pourtaheri S,Sharma A,Savage J,et al.Pelvic retroversion:a compensatory mechanism for lumbar stenosis[J].J Neurosurg Spine,2017,27(2):137-144.
26.Liu H,Li S,Zheng Z,et al.Pelvic retroversion is the key protective mechanism of L4-5 degenerative spondylolisthesis[J].Eur Spine J,2015,24(6):1204-1211.
27.Zhu F,Bao H,Liu Z,et al.Analysis of L5 incidence in normal population use of L5 incidence as a guide in reconstruction of lumbosacral alignment[J].Spine,2014,39(2):140-146.
28.Tempel ZJ,Gandhoke GS,Bolinger BD,et al.The influence of pelvic incidence and lumbar lordosis mismatch on development of symptomatic adjacent level disease following single-level transforaminal lumbar interbody fusion[J].Neurosurgery,2017,80(6):880-886.
29.Harroud A,Labelle H,Joncas J,et al.Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis[J].Eur Spine J,2013,22(4):849-856.