T1骨盆角：成人脊柱侧凸术后矢状面平衡和临床结果的新预测指标。
T1 pelvic angle: a new predictor for postoperative sagittal balance and clinical outcomes in adult scoliosis.
作者信息
Qiao Jun, Zhu Feng, Xu Leilei, Liu Zhen, Zhu Zezhang, Qian Bangping, Sun Xu, Qiu Yong
机构信息
From the Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2014 Dec 1;39(25):2103-7. doi: 10.1097/BRS.0000000000000635.
STUDY DESIGN
A retrospective radiographical study.
OBJECTIVE
To compare the prediction abilities of T1 pelvic angle (TPA) and other parameters for postoperative sagittal balance, and investigate the relationships between these parameters and health-related quality of life.
SUMMARY OF BACKGROUND DATA
Using sagittal vertical axis (SVA) to assess sagittal alignment fails to take account of the pelvic compensation. A new parameter, TPA, has been recommended to represent the global sagittal balance of adult scoliosis.
METHODS
A retrospective review was performed on patients with adult scoliosis undergoing correction surgery from May 2009 to March 2013. The Spearman ρ was used to determine the correlations between the radiographical parameters (preoperative, postoperative, and changes) and the overall Oswestry Disability Index (ODI), visual analogue scale (VAS), and Scoliosis Research Society-22 (SRS-22) questionnaire scores.
RESULTS
Significant correlations were found between the changes of TPA and the changes of lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, SVA, spinosacral angle, ODI, VAS, SRS-22, and pedicle subtraction osteotomy (PSO) degrees (P < 0.05). The changes of SVA were significantly related to the changes of lumbar lordosis, TPA, C7-sacrofemoral distance, ODI, VAS, SRS-22 (P < 0.05) but not PSO degrees (P > 0.05). Significant correlations were found between the changes of spinosacral angle and the changes of thoracolumbar kyphosis, TPA, ODI, VAS, SRS-22, and PSO degrees (P < 0.05). The changes of C7 plumb line to sacrofemoral distance ratio were significantly related to the changes of SVA (P < 0.05), but not the changes of ODI, VAS, SRS-22, or PSO degrees (P > 0.05).
CONCLUSION
TPA could better reflect the postoperative changes of sagittal alignment and health-related quality of life for patients with adult scoliosis. Moreover, the changes of TPA are strongly correlated to the osteotomy degrees for PSO and, TPA could be used as a reference parameter in surgical planning.
LEVEL OF EVIDENCE
研究设计
一项回顾性影像学研究。
目的
比较T1骨盆角（TPA）和其他参数对术后矢状面平衡的预测能力，并研究这些参数与健康相关生活质量之间的关系。
背景数据总结
使用矢状垂直轴（SVA）评估矢状面排列未能考虑骨盆代偿情况。已推荐一个新参数TPA来代表成人脊柱侧凸的整体矢状面平衡。
方法
对2009年5月至2013年3月接受矫正手术的成人脊柱侧凸患者进行回顾性研究。采用Spearman ρ分析影像学参数（术前、术后及变化量）与Oswestry功能障碍指数（ODI）、视觉模拟评分法（VAS）以及脊柱侧凸研究学会22项问卷（SRS-22）评分之间的相关性。
结果
TPA变化与腰椎前凸、骨盆倾斜、骶骨坡度、骨盆入射角、SVA、棘骶角、ODI、VAS、SRS-22及椎弓根截骨术（PSO）度数的变化之间存在显著相关性（P < 0.05）。SVA变化与腰椎前凸、TPA、C7 - 骶股距离、ODI、VAS、SRS-22的变化显著相关（P < 0.05），但与PSO度数无关（P > 0.05）。棘骶角变化与胸腰段后凸、TPA、ODI、VAS、SRS-22及PSO度数的变化之间存在显著相关性（P < 0.05）。C7铅垂线与骶股距离比值的变化与SVA变化显著相关（P < 0.05），但与ODI、VAS、SRS-22或PSO度数的变化无关（P > 0.05）。
结论
TPA能更好地反映成人脊柱侧凸患者术后矢状面排列变化及健康相关生活质量。此外，TPA变化与PSO截骨度数密切相关，TPA可作为手术规划的参考参数。
证据级别
4级。
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