Guo Jichao, Xie Dongxiao, Zhang Jinniu, Ding Wenyuan, Zhao Boyang, Li Zhaohui, Huo Yachong
Department of Orthopedic, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Department of Pediatric Orthopedic, Third Hospital of Hebei Medical University, Shijiazhuang, China.
Front Surg. 2023 Mar 29;10:1111024. doi: 10.3389/fsurg.2023.1111024. eCollection 2023.
Pelvic incidence (PI) minus the lumbar lordosis (LL) angle (PI-LL) correlates with function and disability. It is associated with paravertebral muscle (PVM) degeneration and is a valuable tool for surgical planning of adult degenerative scoliosis (ADS). This study aims to explore the characteristics of PVM in ADS with PI-LL match or mismatch and to identify the risk factors for PI-LL mismatch.
A total of 67 patients with ADS were divided into PI-LL match and mismatch groups. The visual analog scale (VAS), symptom duration, and Oswestry disability index (ODI) were used to assess patients' clinical symptoms and quality of life. The percentage of fat infiltration area (FIA%) of the multifidus muscle at the L1-S1 disc level was measured by using MRI with Image-J software. Sagittal vertical axis, LL, pelvic tilt (PT), PI, sacral slope, and the asymmetric and average degeneration degree of the multifidus were recorded. Logistic regression analysis was done to identify the risk factors for PI-LL mismatch.
In the PI-LL match and mismatch groups, the average FIA% of the multifidus on the convex side was less than that on the concave side ( < 0.05). There was no statistical difference of asymmetric degeneration degree of the multifidus between the two groups ( > 0.05). In the PI-LL mismatch group, the average degeneration degree of the multifidus, VAS, symptom duration, and ODI were significantly higher than that in the PI-LL match group, respectively (32.22 ± 6.98 vs. 26.28 ± 6.23 (%), 4.33 ± 1.60 vs. 3.52 ± 1.46, 10.81 ± 4.83 vs. 6.58 ± 4.23 (month), 21.06 ± 12.58 vs. 12.97 ± 6.49, < 0.05). The average degeneration degree of the multifidus muscle was positively correlated with the VAS, symptom duration, and ODI, respectively ( = 0.515, 0.614, and 0.548, < 0.05). Sagittal plane balance, LL, PT, and the average degeneration degree of the multifidus were the risk factors for PI-LL mismatch (OR: 15.447, 95% CI: 1.274-187.269; OR: 0.001, 95% CI: 0.000-0.099; OR: 107.540, 95% CI: 5.195-2,225.975; OR: 52.531, 95% CI: 1.797-1,535.551, < 0.05).
The PVM on the concave side was larger than that on the convex side in ADS irrespective of whether PI-LL matched or not. PI-LL mismatch could aggravate this abnormal change, which is an important cause of pain and disability in ADS. Sagittal plane imbalance, decreased LL, higher PT, and larger average degeneration degree of the multifidus were independent risk factors for PI-LL mismatch.
骨盆入射角（PI）减去腰椎前凸角（LL）（PI - LL）与功能和残疾相关。它与椎旁肌（PVM）退变有关，是成人退变性脊柱侧凸（ADS）手术规划的重要工具。本研究旨在探讨PI - LL匹配或不匹配的ADS患者中PVM的特征，并确定PI - LL不匹配的危险因素。
67例ADS患者被分为PI - LL匹配组和不匹配组。采用视觉模拟量表（VAS）、症状持续时间和Oswestry功能障碍指数（ODI）评估患者的临床症状和生活质量。使用MRI结合Image - J软件测量L1 - S1椎间盘水平多裂肌的脂肪浸润面积百分比（FIA%）。记录矢状垂直轴、LL、骨盆倾斜（PT）、PI、骶骨倾斜度以及多裂肌的不对称和平均退变程度。进行Logistic回归分析以确定PI - LL不匹配的危险因素。
在PI - LL匹配组和不匹配组中，多裂肌凸侧的平均FIA%小于凹侧（<0.05）。两组多裂肌不对称退变程度无统计学差异（>0.05）。在PI - LL不匹配组中，多裂肌的平均退变程度、VAS、症状持续时间和ODI分别显著高于PI - LL匹配组（32.22±6.98对26.28±6.23（%），4.33±1.60对3.52±1.46，10.81±4.83对6.58±4.23（月），21.06±12.58对12.97±6.49，<0.05）。多裂肌的平均退变程度分别与VAS、症状持续时间和ODI呈正相关（=0.515、0.614和0.548，<0.05）。矢状面平衡、LL、PT和多裂肌的平均退变程度是PI - LL不匹配的危险因素（OR：15.447，95%CI：1.274 - 187.269；OR：0.001，95%CI：0.000 - 0.099；OR：107.540，95%CI：5.195 - 2,225.975；OR：52.531，95%CI：1.797 - 1,535.551，<0.05）。
无论PI - LL是否匹配，ADS患者中PVM凹侧均大于凸侧。PI - LL不匹配会加重这种异常变化，这是ADS患者疼痛和残疾的重要原因。矢状面失衡、LL减小、PT升高和多裂肌平均退变程度增大是PI - LL不匹配的独立危险因素。
