Hu Zongshan, Xu Yanjie, Fan Changsheng, Chen Chunxiao, Li Dongyue, Liu Qiang, Wang Ming, Zhu Zezhang, Qiu Yong, Liu Zhen
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China.
Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, People's Republic of China.
J Bone Joint Surg Am. 2025 Mar 19;107(6):e16. doi: 10.2106/JBJS.24.00829. Epub 2025 Jan 28.
Previous studies have reported normative data for sagittal spinal alignment in asymptomatic adults. The sagittal spinal alignment change in European children was recently reported. However, there is a lack of studies on the normative reference values of sagittal spinal and pelvic alignment and how these parameters change at different growth stages in Chinese children. The aims of this study were to establish the normative reference values of sagittal spinopelvic parameters in Chinese children, to investigate their variation during growth, and to compare these parameters between Chinese and European populations.
The radiographic data of 1,916 healthy Chinese children (female:male sex ratio, 1.02:1; mean age, 11.9 ± 4.3 years) were analyzed in a retrospective, single-center study. Full-spine radiographs were utilized to measure several sagittal parameters, including pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser sign, and triradiate cartilage status).
During skeletal growth, pelvic incidence (PI) increased from 31.3° to 38.4° (p < 0.001), and pelvic tilt (PT) increased from 7.8° to 12.2° (p < 0.001). There were also increases in LL (from 45.0° to 46.3°; p = 0.020) and proximal LL (from 14.5° to 15.9°; p = 0.023). The peak of change in PI occurred between Groups 1 and 2 (from 31.3° to 35.8°; p = 0.011). The peak of change in LL was observed between Groups 1 and 3 (from 45.0° to 47.7°; p = 0.008). The peak of change in proximal LL (from 14.5° to 15.9°; p = 0.039) and distal TK (from 6.1° to 6.9°; p = 0.039) occurred between Groups 1 and 5. A subgroup comparison showed that age and TK were significantly higher in male patients than in female patients across the skeletal growth groups.
This was a comprehensive study of sagittal alignment in a large cohort of Chinese children. These findings can serve as age, sex, and ethnicity-specific reference values for spine surgeons when assessing and planning correction surgery for pediatric patients. The sagittal alignment variations during skeletal growth were different from those in European children, representing a unique cascade effect occurring during skeletal maturation in the Chinese population.
Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
既往研究报道了无症状成年人矢状面脊柱排列的正常数据。最近有报道欧洲儿童矢状面脊柱排列的变化情况。然而，目前缺乏关于中国儿童矢状面脊柱和骨盆排列的正常参考值以及这些参数在不同生长阶段如何变化的研究。本研究的目的是建立中国儿童矢状面脊柱骨盆参数的正常参考值，研究其在生长过程中的变化，并比较中国和欧洲人群的这些参数。
在一项回顾性单中心研究中，分析了1916名健康中国儿童（女性与男性性别比为1.02:1；平均年龄11.9±4.3岁）的影像学数据。采用全脊柱X线片测量多个矢状面参数，包括骨盆参数、T1-T12胸椎后凸（TK）和L1-S1腰椎前凸（LL）。TK分为近端、中段和远端部分，LL分为近端和远端部分。根据骨骼成熟度（基于年龄、Risser征和三骨骺软骨状态）将患者分为5组。
在骨骼生长过程中，骨盆入射角（PI）从31.3°增加到38.4°（p<0.001），骨盆倾斜角（PT）从7.8°增加到12.2°（p<0.001）。LL（从45.0°增加到46.3°；p=0.020）和近端LL（从14.5°增加到15.9°；p=0.023）也有所增加。PI变化的峰值出现在第1组和第2组之间（从31.3°到35.8°；p=0.011）。LL变化的峰值出现在第1组和第3组之间（从45.0°到47.7°；p=0.008）。近端LL（从14.5°到15.9°；p=0.039）和远端TK（从6.1°到6.9°；p=0.039）变化的峰值出现在第1组和第5组之间。亚组比较显示，在整个骨骼生长组中，男性患者的年龄和TK显著高于女性患者。
这是一项对大量中国儿童矢状面排列的综合研究。这些发现可为脊柱外科医生在评估和规划小儿患者的矫正手术时提供年龄、性别和种族特异性的参考值。骨骼生长过程中的矢状面排列变化与欧洲儿童不同，代表了中国人群骨骼成熟过程中独特的级联效应。
预后水平III。有关证据水平的完整描述，请参阅作者须知。
