骨盆T1角（TPA）能有效评估矢状面畸形，并纵向评估影像学手术效果。
T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally.
作者信息
Ryan Devon J, Protopsaltis Themistocles S, Ames Christopher P, Hostin Richard, Klineberg Eric, Mundis Gregory M, Obeid Ibrahim, Kebaish Khaled, Smith Justin S, Boachie-Adjei Oheneba, Burton Douglas C, Hart Robert A, Gupta Munish, Schwab Frank J, Lafage Virginie
机构信息
*Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Neurological Surgery, University of California, San Francisco, CA ‡Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, TX §Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA ¶Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA ‖Department of Orthopaedic Surgery, Bordeaux University Hospital, Bordeaux, France **Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD ††Department of Neurosurgery, University of Virginia, Charlottesville, VA ‡‡Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY §§Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS; and ¶¶Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR.
出版信息
Spine (Phila Pa 1976). 2014 Jul 1;39(15):1203-10. doi: 10.1097/BRS.0000000000000382.
STUDY DESIGN
Retrospective review of a multicenter database of consecutive patients undergoing 3-column osteotomy for treatment of adult spinal deformity (ASD).
OBJECTIVE
To rigorously develop a T1 pelvic angle (TPA) categorization paradigm and use it to assess the surgical management of patients with ASD.
SUMMARY OF BACKGROUND DATA
TPA, the angle between the hips-T1 line and hips-S1 endplate line, is a novel spinopelvic parameter that assesses the combined effect of a loss of lordosis on trunk inclination and pelvic retroversion.
METHODS
A prospective, multicenter database of consecutive patients with ASD was queried to identify the severe deformity threshold and meaningful change values for TPA by correlation with Oswestry Disability Index. A separate multicenter, consecutive, retrospective database of patients with ASD treated with single lumbar 3-column osteotomy was then analyzed at baseline, 3-month, and 1-year follow-up. Subjects were classified into well-aligned or poorly aligned groups at 3 months on the basis of TPA. Patients "deteriorated" if they lost more than 1 meaningful change in TPA between 3 months and 1 year and had TPA more than deformity threshold at 1 year.
RESULTS
The severe deformity threshold for TPA was 20° (Oswestry Disability Index > 40) and the meaningful change was 4.1° (Oswestry Disability Index change = 15). Review of the 3-column osteotomy database identified 179 patients with preoperative severe deformity; 63 were well-aligned (TPA < 15.9°) and 73 were poorly aligned (TPA > 20°) at 3-month follow-up. This newly developed TPA categorization mechanism grouped patients in a manner comparable with the Scoliosis Research Society-Schwab Classification. Subjects who were well-aligned at 3 months had less severe baseline deformity, but received more correction, than poorly aligned subjects. Four well-aligned patients and 13 poorly aligned patients deteriorated between 3 months and 1 year after surgery.
CONCLUSION
TPA accounts for sagittal vertical axis and pelvic tilt and shows great promise as a classification tool. Longitudinal analysis demonstrated undercorrection among patients with more severe preoperative deformity. We propose a surgical target of 10° for TPA.
LEVEL OF EVIDENCE
研究设计
对接受三柱截骨术治疗成人脊柱畸形（ASD）的连续患者的多中心数据库进行回顾性研究。
目的
严格制定T1骨盆角（TPA）分类范式，并用于评估ASD患者的手术治疗。
背景数据总结
TPA是髋部-T1线与髋部-S1终板线之间的夹角，是一种新的脊柱骨盆参数，用于评估脊柱前凸丧失对躯干倾斜和骨盆后倾的综合影响。
方法
查询一个前瞻性、多中心的连续ASD患者数据库，通过与Oswestry功能障碍指数的相关性确定TPA的严重畸形阈值和有意义的变化值。然后对一个单独的多中心、连续、回顾性的接受单节段腰椎三柱截骨术治疗的ASD患者数据库进行基线、3个月和1年随访分析。根据TPA在3个月时将受试者分为排列良好或排列不良组。如果患者在3个月至1年之间TPA丧失超过1个有意义的变化，且1年时TPA超过畸形阈值，则判定为“恶化”。
结果
TPA的严重畸形阈值为20°（Oswestry功能障碍指数>40），有意义的变化为4.1°（Oswestry功能障碍指数变化=15）。对三柱截骨术数据库的回顾确定了179例术前严重畸形患者；在3个月随访时，63例排列良好（TPA<15.9°），73例排列不良（TPA>20°）。这种新开发的TPA分类机制对患者的分组方式与脊柱侧弯研究学会-施瓦布分类法相当。3个月时排列良好的受试者基线畸形较轻，但比排列不良的受试者接受了更多的矫正。4例排列良好的患者和13例排列不良的患者在术后3个月至1年之间病情恶化。
结论
TPA考虑了矢状垂直轴和骨盆倾斜，作为一种分类工具显示出巨大的前景。纵向分析表明，术前畸形较严重的患者存在矫正不足的情况。我们提出TPA的手术目标为10°。
证据级别
4级。
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