目的:本研究的目的是探讨腰椎退行性疾病患者正立向矢状位变化与PI的相关性。并研究了Roussouly类型之间姿势变化的差异。
方法:回顾性纳入209例腰椎退行性疾病患者。所有患者均以站立和坐姿接受了侧向全身成像。矢状参数包括SVA,OD-HA,PT,PI,PT/PI,SS,LL,TK,上LL(L1-L4)和下LL(L4-S1)在站立和坐姿测量,并在两个位置之间比较参数。分析PI与腰骨盆变化的相关性。比较了不同Rousouly类型之间的姿势变化。
结果:从站立到坐着,除PI外的所有参数都发生了显著变化,包括SVA,OD-HA,PT,PT/PI,SS,LL,TK,上部LL和下部LL。较低LL对全球LL的贡献大于较高LL。PI与ΔPT有显著相关性,ΔSS,ΔLL,Δ上LL和Δ下LL。从站到坐,4型患者的ΔPT最明显,ΔSS和ΔLL,类型3和类型4的ΔLowerLL大于类型1和类型2。
结论:在退行性疾病患者中,PI在确定从站立到坐的腰骨盆变化程度方面起着重要作用。在不同的Roussouly类型中,4型患者的PT变化最明显,SS和LL,表明骨盆和腰椎相对更大的灵活性。
OBJECTIVE: The aim of this study was to explore the correlation between PI and standing-to-sitting changes of the sagittal alignment in patients with lumbar degenerative diseases, and investigate the differences in posture changes among Roussouly types.
METHODS: A total of 209 patients with lumbar degenerative disease were retrospectively included in this study. All the patients received lateral full body imaging in both standing and sitting positions. Sagittal parameters including SVA, OD-HA, PT, PI, PT/PI, SS, LL, TK, Upper LL (L1-L4) and Lower LL (L4-S1) were measured in both standing and sitting position, and the parameters were compared between two positions. The correlations between PI and lumbo-pelvic changes were analyzed. The postural changes were compared among different Roussouly types.
RESULTS: From standing to sitting, all the parameters except PI significantly changed, including SVA, OD-HA, PT, PT/PI, SS, LL, TK, Upper LL and Lower LL. The contribution of lower LL was greater to global LL than upper LL. PI had a significant correlation with ΔPT, ΔSS, ΔLL, ΔUpper LL and ΔLower LL. From standing to sitting, type 4 patients had the most pronounced ΔPT, ΔSS and ΔLL, and ΔLower LL of types 3 and 4 were greater than that of types 1 and 2.
CONCLUSIONS: In patients with degenerative disease, PI plays an important role in determining the extent of lumbo-pelvic changes from standing to sitting. Among different Roussouly types, type 4 patients have the most pronounced changes of PT, SS and LL, suggesting the relatively greater flexibility of pelvis and lumbar spine.