腰椎退变与骨盆解剖参数之间的关联。

Association Between Lumbar Spinal Degeneration and Anatomic Pelvic Parameters.

作者信息

Strube Patrick, Pumberger Matthias, Sonnow Lena, Zippelius Timo, Nowack Dimitri, Zahn Robert K, Putzier Michael

机构信息

Orthopaedic Department, Jena University Hospital, Campus Eisenberg, Eisenberg.

Orthopaedic Department, Center for Musculoskeletal Surgery, Charité-University Medicine Berlin.

出版信息

Clin Spine Surg. 2018 Jul;31(6):263-267. doi: 10.1097/BSD.0000000000000660.

DOI:10.1097/BSD.0000000000000660

PMID:29863597

Abstract

STUDY DESIGN

Retrospective cohort study.

OBJECTIVE

The objective was to prove the association between anatomic pelvis parameters and specific types of lumbar spinal degeneration.

SUMMARY OF BACKGROUND DATA

Different spinopelvic sagittal profile types are suggested to be associated with specific degenerative lumbar spine pathologies. Because pelvic morphology plays a key role defining the spinal shape as well as its load and function it thereby potentially predisposes the development of spinal degeneration.

MATERIALS AND METHODS

Patients with symptomatic lumbar spinal degeneration who were surgically treated in 2 spine departments from March 2011 until August 2016 were included in this retrospective analysis. Single-level degenerative pathologies were classified as lumbar disc herniation (LDH), degenerative disc disease (DDD), lumbar spinal stenosis (LSS), and degenerative spondylolisthesis (DSPL). The constant anatomic pelvic parameters pelvic incidence (PI), pelvic radius (PR), and sacral table angle (STA) were assessed in lateral radiographs of the lumbar spine and compared between the pathologies.

RESULTS

In total, 249 patients were assigned to the LDH (n=73), DDD (n=67), LSS (n=42), and DSPL (n=67) groups. Group comparisons revealed significant differences in the anatomic pelvic parameters PR (LDH, 139.5±10.8 mm; DDD, 135.9±14.0 mm; LSS, 127.8±14.3 mm; DSPL, 135.8±12.7 mm; P<0.001), PI (LDH, 53.1±10.0 degrees; DDD, 50.0±9.9 degrees; LSS, 54.5±9.6 degrees; DSPL, 57.1±10.8 degrees; P=0.001), and STA (LDH, 95.3±12.7 degrees; DDD, 105.4±9.0 degrees; LSS, 105.9±11.5 degrees; DSPL, 98.6±9.5 degrees; P<0.001). Post hoc tests indicated significant differences between the PR of the LSS group and that of all other subgroups (P<0.012), the PI of the DDD group and that of DSPL (P<0.001), and the STA of the LDH/DSPL groups and that of the LSS/DDD group (P<0.005).

CONCLUSIONS

We found all the constant anatomic parameters to be specific for distinct types of degeneration, suggesting pelvis shape is a predisposing factor for their development.

LEVEL OF EVIDENCE

Level III.

摘要

研究设计

回顾性队列研究。

目的

旨在证明解剖学骨盆参数与特定类型腰椎退变之间的关联。

背景数据总结

不同的脊柱骨盆矢状面形态类型被认为与特定的退行性腰椎病变相关。由于骨盆形态在确定脊柱形状及其负荷和功能方面起着关键作用，因此它可能会引发脊柱退变。

材料与方法

纳入2011年3月至2016年8月在两个脊柱科室接受手术治疗的有症状腰椎退变患者进行这项回顾性分析。单节段退行性病变分为腰椎间盘突出症（LDH）、椎间盘退变疾病（DDD）、腰椎管狭窄症（LSS）和退行性椎体滑脱（DSPL）。在腰椎侧位X线片上评估恒定的解剖学骨盆参数骨盆入射角（PI）、骨盆半径（PR）和骶骨平台角（STA），并在不同病变之间进行比较。

结果

总共249例患者被分为LDH组（n = 73）、DDD组（n = 67）、LSS组（n = 42）和DSPL组（n = 67）。组间比较显示解剖学骨盆参数PR（LDH，139.5±10.8mm；DDD，135.9±14.0mm；LSS，127.8±14.3mm；DSPL，135.8±12.7mm；P<0.001）、PI（LDH，53.1±10.0度；DDD，50.0±9.9度；LSS，54.5±9.6度；DSPL，57.1±10.8度；P = 0.001）和STA（LDH，95.3±12.7度；DDD，105.4±9.0度；LSS，105.9±11.5度；DSPL，98.6±9.5度；P<0.001）存在显著差异。事后检验表明LSS组的PR与所有其他亚组的PR之间存在显著差异（P<0.012），DDD组的PI与DSPL组的PI之间存在显著差异（P<0.001），LDH/DSPL组的STA与LSS/DDD组的STA之间存在显著差异（P<0.005）。