成人脊柱畸形患者年龄调整后对线及下肢代偿的全身分析
Full-Body Analysis of Age-Adjusted Alignment in Adult Spinal Deformity Patients and Lower-Limb Compensation.
作者信息
Jalai Cyrus M, Cruz Dana L, Diebo Bassel G, Poorman Gregory, Lafage Renaud, Bess Shay, Ramchandran Subaraman, Day Louis M, Vira Shaleen, Liabaud Barthélemy, Henry Jensen K, Schwab Frank J, Lafage Virginie, Passias Peter G
机构信息
Department of Orthopedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.
出版信息
Spine (Phila Pa 1976). 2017 May 1;42(9):653-661. doi: 10.1097/BRS.0000000000001863.
STUDY DESIGN
Single-center retrospective review.
OBJECTIVE
The present study evaluates the effect of increasing spinal deformity deviation from age-adjusted alignment ideals on lower extremity compensation.
SUMMARY OF BACKGROUND DATA
Although current understanding of compensatory mechanisms in adult spinal deformity (ASD) is progressing due to full-body stereographic assessment, the effect of age-adjusted deformity targets on lower-limb compensation remains unexamined.
METHODS
ASD patients 18 years or older with biplanar full-body stereographic x-rays were included. Patients were stratified into age cohorts: younger than 40 years, 40-65 years, 65 years or older. Age-specific alignment goals (IDEAL) for pelvic tilt (PT), spinopelvic mismatch (PI-LL), sagittal vertical axis (SVA), and T1 pelvic angle (TPA) were calculated for each patient using published formulas and compared to patients' real (ACTUAL) radiographic parameters. The difference between ACTUAL and IDEAL alignment (OFFSET) was calculated. Analysis of variance compared ACTUAL, IDEAL, and OFFSET between age groups, and OFFSET was correlated with lower-limb compensation (sacrofemoral angle, pelvic shift, knee angle, ankle angle).
RESULTS
Seven hundred seventy-eight patients with (74.1% female) were included. ACTUAL and IDEAL alignments matched for PT (P = 0.37) in patients younger than 40 years, SVA (P = 0.12) in patients 40 to 65 years and PT, SVA, and TPA (P > 0.05) in patients 65 years or older. SVA and TPA OFFSETs decreased significantly with increasing age (P < 0.001). Hip extension correlated with all OFFSETs in patients younger than 40 years (positively with PT, PI-LL, TPA; negatively with SVA). Knee flexion correlated with PI-LL, SVA, and TPA, across all age groups with strongest correlations (0.525 < r < 0.605) in patients 40 to 65 years. Ankle dorsiflexion only correlated positively with PT and PI-LL offsets in older (older than 40 years) age groups. Posterior pelvic displacement correlated positively with all OFFSET groups, and was highest (0.526 < r <0.712) in patients ages 40 to 65 years.
CONCLUSION
Age-adjusted ideals for sagittal alignment provide targets for patients with ASD. Offsets from actual alignment (more severe sagittal deformity) revealed differential recruitment of lower-limb extension, which varied significantly with age.
LEVEL OF EVIDENCE
研究设计
单中心回顾性研究。
目的
本研究评估脊柱畸形偏离年龄调整后的对线理想值增加对下肢代偿的影响。
背景数据总结
尽管由于全身立体摄影评估，目前对成人脊柱畸形（ASD）代偿机制的理解正在取得进展，但年龄调整后的畸形目标对下肢代偿的影响仍未得到研究。
方法
纳入年龄在18岁及以上且有双平面全身立体摄影X线片的ASD患者。患者被分为年龄组：40岁以下、40 - 65岁、65岁及以上。使用已发表的公式为每位患者计算骨盆倾斜（PT）、脊柱骨盆失配（PI-LL）、矢状垂直轴（SVA）和T1骨盆角（TPA）的年龄特异性对线目标（IDEAL），并与患者实际的（ACTUAL）影像学参数进行比较。计算ACTUAL与IDEAL对线之间的差异（OFFSET）。方差分析比较各年龄组之间的ACTUAL、IDEAL和OFFSET，并且OFFSET与下肢代偿（骶股角、骨盆移位、膝关节角度、踝关节角度）相关。
结果
纳入778例患者（74.1%为女性）。40岁以下患者的PT的ACTUAL与IDEAL对线匹配（P = 0.37），40至65岁患者的SVA（P = 0.12）以及65岁及以上患者的PT、SVA和TPA（P > 0.05）匹配。SVA和TPA OFFSET随着年龄增长显著降低（P < 0.001）。40岁以下患者中，髋关节伸展与所有OFFSET相关（与PT、PI-LL、TPA呈正相关；与SVA呈负相关）。膝关节屈曲与PI-LL、SVA和TPA相关，在所有年龄组中，40至65岁患者的相关性最强（0.525 < r < 0.605）。仅在年龄较大（40岁以上）的年龄组中，踝关节背屈与PT和PI-LL偏移呈正相关。骨盆后移与所有OFFSET组呈正相关，在40至65岁患者中最高（0.526 < r < 0.712）。
结论
矢状面排列的年龄调整理想值为ASD患者提供了目标。实际排列的偏移（更严重的矢状面畸形）显示下肢伸展的不同募集，其随年龄有显著变化。
证据水平
3级。
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