| 摘要: |
| 目的 评估成人脊柱侧凸患者长时间步行前后整体和局部的矢状面影像学参数。方法 回顾性纳入2016年1月至2018年6月于海军军医大学（第二军医大学）长征医院就诊的98例成人脊柱侧凸患者，根据行走前矢状面参数将患者分为两组：代偿组（行走前矢状面平衡，矢状面躯干偏移<40 mm且骨盆倾斜角>20°）和失代偿组（行走前矢状面失平衡，矢状面躯干偏移≥ 40 mm且骨盆倾斜角>20°）。步行15 min前后拍摄站立位全脊柱正侧位X线片，测量脊柱矢状面参数，包括矢状面躯干偏移、胸椎后凸角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角。比较两组步行15 min前后脊柱矢状面参数，并对每组步行15 min前后矢状面躯干偏移变化值与其余矢状面参数变化值进行相关性分析。结果 代偿组19例，其中女16例、男3例，平均年龄为（64.1±5.9）岁，BMI为（24.2±4.6）kg/m2；失代偿组79例，其中女67例、男12例，平均年龄为（66.7±7.2）岁，BMI为（24.9±5.1）kg/m2，两组患者性别构成比、年龄、BMI差异均无统计学意义（P均>0.05）。步行前，代偿组患者腰椎前凸角大于失代偿组（Z=2.784，P=0.003），骨盆入射角-腰椎前凸角和矢状面躯干偏移均小于失代偿组（Z=1.953，P=0.028；Z=3.815，P<0.01）；两组间骨盆倾斜角、骶骨倾斜角、胸椎后凸角差异均无统计学意义（P均>0.05）。步行15 min后，两组间骨盆倾斜角、骶骨倾斜角、腰椎前凸角、胸椎后凸角、骨盆入射角-腰椎前凸角、矢状面躯干偏移差异均无统计学意义（P均>0.05）。与步行前比较，代偿组和失代偿组患者步行15 min后骶骨倾斜角、骨盆入射角-腰椎前凸角、矢状面躯干偏移均增大（代偿组Z=1.718、P=0.043，Z=2.198、P=0.015，Z=3.875、P<0.01；失代偿组Z=1.842、P=0.031，Z=1.943、P=0.021，Z=2.917、P=0.002），骨盆倾斜角和腰椎前凸角均减小（代偿组Z=1.639、P=0.047，Z=3.624、P<0.01；失代偿组Z=1.812、P=0.039，Z=3.893、P<0.01）；失代偿组患者步行15 min后胸椎后凸角也较步行前增大（Z=2.287，P=0.012）。代偿组、失代偿组患者步行15 min前后矢状面躯干偏移变化值均与骨盆倾斜角变化值呈负相关（rs=-0.519、-0.625，P=0.024、0.001），与骶骨倾斜角变化值、腰椎前凸角变化值、骨盆入射角-腰椎前凸角变化值均呈正相关（代偿组rs=0.519、0.645、0.645，P均<0.05；失代偿组rs=0.625、0.407、0.407，P均<0.01）。结论 成人脊柱侧凸患者长时间行走后矢状面平衡的代偿机制逐渐减弱或消失，骨盆及脊柱伸肌肌群的疲劳可能是代偿机制消失的原因。对于初次就诊时矢状面躯干偏移<40 mm、骨盆倾斜角>20°的患者，建议在行走15 min后再次拍摄X线片重新评估是否存在潜在的矢状面失平衡。 |
| 关键词: 成人脊柱侧凸 矢状面参数 矢状面失衡 影像学评估 步行 |
| DOI：10.16781/j.0258-879x.2020.03.0248 |
| 投稿时间：2019-04-17修订日期：2019-06-26 |
| 基金项目:国家自然科学基金（81772305），上海市教育委员会晨光计划（14CG37）. |
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| Dynamic evaluation of sagittal imbalance after a long walk in adult scoliosis patients |
| YIN Jia1△,ZHANG Ke1△,MA Xiao1,LI Tang-bo2,GAO Rui1,ZHOU Xu-hui1* |
(1. Department of Orthopaedics, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Orthopaedics, Special Medical Center of PLA Rocket Force, Beijing 100088, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To assess whole and regional spinal sagittal radiographic parameters before and after a long walk in adult scoliosis patients. Methods A total of 98 adult scoliosis patients, who were admitted to Changzheng Hospital of Naval Medical University (Second Military Medical University) from Jan. 2016 to Jun. 2018, were retrospectively included. According to sagittal radiographic parameters before a long walk, the patients were assigned to two groups:compensated group (sagittal balance before walking, with sagittal vertical axis[SVA]<40 mm and pelvic tilt[PT]>20°) and decompensated group (sagittal imbalance before walking, with SVA ≥ 40 mm and PT>20°). The anteroposterior and lateral radiographs of whole spine were taken before and after a 15-min walk, and the sagittal radiographic parameters were measured, including SVA, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PT and sacral slope (SS). The sagittal radiographic parameters were compared between the two groups before and after a 15-min walk. The correlations between the differences of SVA and other sagittal parameters before and after a 15-min walk were analyzed in two groups. Results There were 19 patients in the compensated group, including 16 females and 3 males, with an average age of (64.1±5.9) years and a body mass index (BMI) of (24.2±4.6) kg/m2. There were 79 patients in the decompensated group, including 67 females and 12 males, with an average age of (66.7±7.2) years and a BMI of (24.9±5.1) kg/m2. There were no significant differences in age, gender or BMI between the two groups (all P>0.05). Before walking, the LL was significantly larger in the compensated group than that in the decompensated group (Z=2.784, P=0.003), and the PI-LL and SVA were significantly smaller in the compensated group than those in the decompensated group (Z=1.953, P=0.028; Z=3.815, P<0.01). There were no significant differences in PT, SS or TK between the two groups (all P>0.05). After a 15-min walk, there were no significant differences in PT, SS, LL, TK, PI-LL or SVA between the two groups (all P>0.05). Compared with before walking, the SS, PI-LL and SVA were significantly increased after a 15-min walk in the compensated and decompensated groups (compensated group Z=1.718, P=0.043; Z=2.198, P=0.015; Z=3.875, P<0.01; and decompensated group Z=1.842, P=0.031; Z=1.943, P=0.021; Z=2.917, P=0.002); however, the PT and LL were both significantly decreased after walking (compensated group Z=1.639, P=0.047; Z=3.624, P<0.01; and decompensated group Z=1.812, P=0.039; Z=3.893, P<0.01). In the decompensated group, the TK was also significantly increased after walking versus before walking (Z=2.287, P=0.012). The difference of SVA before and after 15-min walk was negatively correlated with the difference of PT in the compensated and decompensated groups (rs=-0.519, -0.625; P=0.024, 0.001), and was positively correlated with differences of SS, LL and PI-LL (compensated group rs0.519, 0.645, and 0.645, all P<0.05; and decompensated group rs0.625, 0.407, and 0.407, all P<0.01). Conclusion The compensatory mechanisms of sagittal balance in adult scoliosis patients are gradually weakened or disappeared after a long walk, and the fatigue of pelvic and spinal extensor muscles may be the reasons. For the adult scoliosis patients with SVA<40 mm and PT>20°, it is suggested that the anteroposterior and lateral radiographs of whole spine should be taken again after a 15-min walk to re-evaluate the potential sagittal imbalance. |
| Key words: adult scoliosis sagittal parameters sagittal imbalance radiographic evaluation walking |
