腰椎矢状位力线分型及临床意义
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摘要
脊柱-骨盆矢状面平衡参数是目前脊柱外科关注的热点,但其生物力学机制国内外尚未得到明确阐释。伴随腰椎退行性疾病发病率的增加,腰椎矢状力线分析研究表明,多种腰椎退行性疾病与矢状面失衡密切相关,恢复重建生理曲度是维持正常腰椎生物力学功能的基础。研究生理状态下的腰椎矢状序列特点及其退变趋势可以帮助医生从病理状态的腰椎序列逆推,通过手术重建生理状态的腰椎矢状力线,可能有益于减轻邻近节段退变。然而,腰椎矢状位退变过程中受到多种因素影响,脊柱代偿机制复杂,目前的认识还很有限,未来有待更多的脊柱骨盆参数及矢状位力线的研究。
The spinal-pelvic sagittal parameters are a hot topic in spinal surgery, but the biomechanical mechanism remains unclear. With the increasing incidence of lumbar degenerative diseases, researches on the lumbar sagittal alignment have shown that a variety of lumbar degenerative diseases are closely related to sagittal imbalance. Therefore, restoring and reconstructing the physiological curvature is essential to maintain the normal biomechanical functions of lumbar spine. Investigating the characteristics of spinal sagittal alignment and the degenerative trend can help doctors to reversely deduct the pathological condition, and to reconstruct the physiological sagittal alignment, which may alleviate the degeneration of adjacent segments. However, due to various influencing factors and complex spinal compensatory mechanism, our cognition is still limited, and more remains to be done to explore the spinal pelvic parameters and sagittal alignment.
The spinal-pelvic sagittal parameters are a hot topic in spinal surgery, but the biomechanical mechanism remains unclear. With the increasing incidence of lumbar degenerative diseases, researches on the lumbar sagittal alignment have shown that a variety of lumbar degenerative diseases are closely related to sagittal imbalance. Therefore, restoring and reconstructing the physiological curvature is essential to maintain the normal biomechanical functions of lumbar spine. Investigating the characteristics of spinal sagittal alignment and the degenerative trend can help doctors to reversely deduct the pathological condition, and to reconstruct the physiological sagittal alignment, which may alleviate the degeneration of adjacent segments. However, due to various influencing factors and complex spinal compensatory mechanism, our cognition is still limited, and more remains to be done to explore the spinal pelvic parameters and sagittal alignment.
引文
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[2] Chen RQ,Hosogane N,Watanabe K,et al.Reliability analysis of spino-pelvic parameters in adult spinal deformity:a comparison of whole spine and pelvic radiographs[J].Spine,2016,41(4):320-327.
[3] Tian H,Wu A,Guo M,et al.Adequate restoration of disc height and segmental lordosis by lumbar interbody fusion decreases adjacent segment degeneration[J].World Neurosurg,2018,118:856-864.doi:10.1016/j.wneu.
[4] 龚克.正常人群腰椎椎间高度指数、椎间角度、腰椎前凸角的研究分析及椎间高度指数与椎间盘 Pfirrmann分级的相关性研究[D].西安:中国人民解放军空军军医大学,2018.
[5] Celestre PC,Dimar JR,Glassman SD.Spinopelvic parameters:lumbar lordosis,pelvic incidence,pelvic tilt,and sacral slope:what does a spine surgeon need to know to plan a lumbar deformity correction?[J].Neurosurg Clin N Am,2018,29(3):323-329.
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[12] Zhang F,Zhang K,Tian HJ,et al.Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults[J].J Orthop Surg Res,2018,13(1):34.
[13] 王力,邱南海,余铭.椎弓根钉固定加椎间融合修复腰椎滑脱症:恢复椎间隙高度与否对脊柱序列及功能的影响[J].中国组织工程研究,2017,21(35):5636-5643.WANG Li,QIU Nanhai,YU Ming.Pedicle fixation combined with intervertebral fusion for lumbar spondylolithesis:whether restoring disc height affects the biomechanics and spinal function[J].Chinese Journal of Tissue Engineering Research,2017,21(35):5636-5643.
[14] Umehara S,Zindrick MR,Patwardhan AG,et al.The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments[J].Spine,2000,25(13):1617-1624.
[15] Keorochana G,Taghavi CE,Lee KB,et al.Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine:an analysis using positional MRI[J].Spine,2011,36(11):893-898.
[16] Cheng X,Zhang F,Zhang K,et al.Effect of single-level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients with lumbar degenerative disease[J].World Neurosurg,2018,109:244-251.doi:10.1016/j.wneu.
[17] Jab?ońska-Sudo?K,Maciejczak A.Relationship between the spino-pelvic parameters and the slip grade in isthmic spondylolisthesis[J].Neurol Neurochir Pol,2015,49(6):381-388.
[18] Agius R,Galea R,Fava S.Bone mineral density and intervertebral disc height in type 2 diabetes[J].J Diabetes Complications,2016,30(4):644-650.
[19] Teichtahl AJ,Urquhart DM,Wang Y,et al.A Dose-response relationship between severity of disc degeneration and intervertebral disc height in the lumbosacral spine[J].Arthritis Res Ther,2015,17:297.doi:10.1186/s13075-015-0820-1.
[20] Barrey C,Roussouly P,Le Huec JC,et al.Compensatory mechanisms contributing to keep the sagittal balance of the spine[J].Eur Spine J,2013,22(Suppl 6):834-841.
[21] Cheng X,Zhang K,Sun X,et al.Analysis of compensatory mechanisms in the pelvis and lower extremities in patients with pelvic incidence and lumbar lordosis mismatch[J].Gait & Posture,2017,56:14-18.doi:10.1016/j.gaitpost.
[22] Terran J,Schwab F,Shaffrey CI,et al.The SRS-Schwab adult spinal deformity classification:assessment and clinical correlations based on a prospective operative and nonoperative cohort[J].Neurosurgery,2013,73(4):559-568.
[23] Ha KY,Jang WH,Kim YH,et al.Clinical relevance of the srs-schwab classification for degenerative lumbar scoliosis[J].Spine,2016,41(5):282-288.
[24] Sebaaly A,Grobost P,Mallam L,et al.Description of the sagittal alignment of the degenerative human spine[J].Eur Spine J,2018,27(2):489-496.
[25] Zhao X,Du L,Xie Y,et al.Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion:a finite element analysis[J].World Neurosurg,2018,114:114-120.doi:10.1016/j.wneu.
[2] Chen RQ,Hosogane N,Watanabe K,et al.Reliability analysis of spino-pelvic parameters in adult spinal deformity:a comparison of whole spine and pelvic radiographs[J].Spine,2016,41(4):320-327.
[3] Tian H,Wu A,Guo M,et al.Adequate restoration of disc height and segmental lordosis by lumbar interbody fusion decreases adjacent segment degeneration[J].World Neurosurg,2018,118:856-864.doi:10.1016/j.wneu.
[4] 龚克.正常人群腰椎椎间高度指数、椎间角度、腰椎前凸角的研究分析及椎间高度指数与椎间盘 Pfirrmann分级的相关性研究[D].西安:中国人民解放军空军军医大学,2018.
[5] Celestre PC,Dimar JR,Glassman SD.Spinopelvic parameters:lumbar lordosis,pelvic incidence,pelvic tilt,and sacral slope:what does a spine surgeon need to know to plan a lumbar deformity correction?[J].Neurosurg Clin N Am,2018,29(3):323-329.
[6] Hayden AM,Hayes AM,Brechbuhler JL,et al.The effect of pelvic motion on spinopelvic parameters[J].Spine J,2018,18(1):173-178.
[7] Roussouly P,Gollogly S,Berthonnaud E,et al.Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position[J].Spine,2005,30(3):346-353.
[8] Lee CS,Chung SS,Kang KC,et al.Normal patterns of sagittal alignment of the spine in young adults radiological analysis in a Korean population[J].Spine,2011,36(25):1648-1654.
[9] Dolphens M,Cagnie B,Coorevits P,et al.Classification system of the sagittal standing alignment in young adolescent girls[J].Eur Spine J,2014,23(1):216-225.
[10] Yang M,Guo H,Wang X,et al.The morphology of sagittal alignment in asymptomatic volunteers of East China:A novel radiological classification[J].J Orthop Sci,2017,22(6):1015-1020.
[11] Laouissat F,Sebaaly A,Gehrchen M,et al.Classification of normal sagittal spine alignment:refounding the Roussouly classification[J].Eur Spine J,2018,27(8):2002-2011.
[12] Zhang F,Zhang K,Tian HJ,et al.Correlation between lumbar intervertebral disc height and lumbar spine sagittal alignment among asymptomatic Asian young adults[J].J Orthop Surg Res,2018,13(1):34.
[13] 王力,邱南海,余铭.椎弓根钉固定加椎间融合修复腰椎滑脱症:恢复椎间隙高度与否对脊柱序列及功能的影响[J].中国组织工程研究,2017,21(35):5636-5643.WANG Li,QIU Nanhai,YU Ming.Pedicle fixation combined with intervertebral fusion for lumbar spondylolithesis:whether restoring disc height affects the biomechanics and spinal function[J].Chinese Journal of Tissue Engineering Research,2017,21(35):5636-5643.
[14] Umehara S,Zindrick MR,Patwardhan AG,et al.The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments[J].Spine,2000,25(13):1617-1624.
[15] Keorochana G,Taghavi CE,Lee KB,et al.Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine:an analysis using positional MRI[J].Spine,2011,36(11):893-898.
[16] Cheng X,Zhang F,Zhang K,et al.Effect of single-level transforaminal lumbar interbody fusion on segmental and overall lumbar lordosis in patients with lumbar degenerative disease[J].World Neurosurg,2018,109:244-251.doi:10.1016/j.wneu.
[17] Jab?ońska-Sudo?K,Maciejczak A.Relationship between the spino-pelvic parameters and the slip grade in isthmic spondylolisthesis[J].Neurol Neurochir Pol,2015,49(6):381-388.
[18] Agius R,Galea R,Fava S.Bone mineral density and intervertebral disc height in type 2 diabetes[J].J Diabetes Complications,2016,30(4):644-650.
[19] Teichtahl AJ,Urquhart DM,Wang Y,et al.A Dose-response relationship between severity of disc degeneration and intervertebral disc height in the lumbosacral spine[J].Arthritis Res Ther,2015,17:297.doi:10.1186/s13075-015-0820-1.
[20] Barrey C,Roussouly P,Le Huec JC,et al.Compensatory mechanisms contributing to keep the sagittal balance of the spine[J].Eur Spine J,2013,22(Suppl 6):834-841.
[21] Cheng X,Zhang K,Sun X,et al.Analysis of compensatory mechanisms in the pelvis and lower extremities in patients with pelvic incidence and lumbar lordosis mismatch[J].Gait & Posture,2017,56:14-18.doi:10.1016/j.gaitpost.
[22] Terran J,Schwab F,Shaffrey CI,et al.The SRS-Schwab adult spinal deformity classification:assessment and clinical correlations based on a prospective operative and nonoperative cohort[J].Neurosurgery,2013,73(4):559-568.
[23] Ha KY,Jang WH,Kim YH,et al.Clinical relevance of the srs-schwab classification for degenerative lumbar scoliosis[J].Spine,2016,41(5):282-288.
[24] Sebaaly A,Grobost P,Mallam L,et al.Description of the sagittal alignment of the degenerative human spine[J].Eur Spine J,2018,27(2):489-496.
[25] Zhao X,Du L,Xie Y,et al.Effect of lumbar lordosis on the adjacent segment in transforaminal lumbar interbody fusion:a finite element analysis[J].World Neurosurg,2018,114:114-120.doi:10.1016/j.wneu.