比较儿童和成人人群的脊柱骨盆结构和 Roussouly 分型。
Comparison of Spinopelvic Configuration and Roussouly Alignment Types Between Pediatric and Adult Populations.
机构信息
Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg.
Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Paris.
出版信息
Spine (Phila Pa 1976). 2022 Sep 15;47(18):1303-1313. doi: 10.1097/BRS.0000000000004411. Epub 2022 Jun 29.
STUDY DESIGN
Retrospective cross-sectional study.
OBJECTIVE
The aim was to describe spinopelvic alignment types by pelvic incidence (PI) and age to compare the Roussouly classification between pediatric and adult populations.
SUMMARY OF BACKGROUND DATA
The Roussouly classification was validated for adults. Alignment types may vary during growth.
MATERIALS AND METHODS
Radiographs of 1706 non pathologic individuals (5-49 yr) were analyzed. Individuals ≤19 years were stratified by chronological age and skeletal maturity (triradiate cartilage, Risser), and compared with adults. Global and spinopelvic alignment parameters were assessed. Roussouly Types 1, 2, 3, 3A (anteverted pelvis), and 4 were determined. The distribution of parameters was analyzed by Bayesian inference. The relationship between PI and age by Roussouly type was modeled by linear regression.
RESULTS
The Sagittal Vertical Axis C7 decreased during growth and was significantly smaller in adults (20-34 yr) (Pr>0.99). Thoracic kyphosis and lumbar lordosis increased during growth and were larger in adults (Pr<0.025). Lordosis increased mainly in the cranial arch (Pr<0.025). PI and pelvic tilt increased during growth and were larger in adults (Pr<0.025). In children and adolescents, PI<45° represented the largest proportion, significantly larger compared with adults (Pr>0.99). Proportions of Roussouly Types 1 and 2 were similar throughout ages. Types 3 and 4 were rarer during the prepubertal period (Pr<0.025). The proportion of Type 3A was significantly higher in children and adolescents (Pr>0.99). Linear regression showed that Type 4 had the largest PI increase with age, with significantly higher curve slope compared with other types (Pr>0.9999). Types 3, 3A and 2 had similar slopes and lowest PI increase with age.
CONCLUSION
Global and spinopelvic alignment changed during childhood and adolescence, leading to different kyphosis and lordosis distribution compared with adults. Growth-related PI increase influenced Roussouly types with typical predominance of Type 3A in the pediatric population and larger PI increase in Type 4.
LEVEL OF EVIDENCE
Level III.
研究设计
回顾性的横断面研究。
目的
本研究旨在通过骨盆入射角（PI）和年龄描述脊柱骨盆矢状面的排列类型，以比较小儿和成人的 Roussouly 分类。
背景资料概要
Roussouly 分类已被验证适用于成人。在生长过程中，排列类型可能会发生变化。
材料与方法
分析了 1706 例非病理性个体（5-49 岁）的影像学资料。≤19 岁的个体按年龄和骨骼成熟度（三辐射软骨，Risser）进行分层，并与成年人进行比较。评估了整体和脊柱骨盆排列参数。确定了 Roussouly 类型 1、2、3、3A（前倾骨盆）和 4。通过贝叶斯推断分析参数的分布。通过线性回归建立 PI 与 Roussouly 类型之间的年龄关系。
结果
颈椎矢状垂直轴 C7 在生长过程中减小，且在成年人（20-34 岁）中显著较小（Pr>0.99）。胸椎后凸和腰椎前凸在生长过程中增加，且在成年人中更大（Pr<0.025）。前凸主要在颅弓增加（Pr<0.025）。PI 和骨盆倾斜在生长过程中增加，且在成年人中更大（Pr<0.025）。在儿童和青少年中，PI<45°代表最大比例，与成年人相比显著更大（Pr>0.99）。各年龄段 Roussouly 类型 1 和 2 的比例相似。3 型和 4 型在青春期前较少见（Pr<0.025）。3A 型的比例在儿童和青少年中显著更高（Pr>0.99）。线性回归显示，4 型的 PI 随年龄增加的增长率最大，斜率明显高于其他类型（Pr>0.9999）。3 型、3A 型和 2 型的斜率相似，PI 随年龄增加的增长率最低。
结论
在儿童和青少年时期，整体和脊柱骨盆排列发生变化，导致与成年人相比，后凸和前凸分布不同。与年龄相关的 PI 增加影响 Roussouly 类型，小儿人群中典型的 3A 型比例较高，4 型 PI 增加较大。
证据水平
III 级。
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