-
摘要:背景 为评估脊柱骨盆矢状位序列平衡,脊柱骨盆影像学参数近年来成为研究热点,骶骨形态参数作为一种新型参数体系而备受瞩目。关联因素的研究对于提高骶骨形态参数的临床应用价值有着重大意义。目的 探讨年龄、体位、性别因素对骶骨形态参数的影响。方法 选取2013年1月- 2020年12月于解放军总医院第一医学中心体检人群的脊柱全长片和脊柱核磁影像资料,筛选并测量120例未成年人(站立位)、131例成年人(站立位)和88例成年人(仰卧位)的骶骨形态参数(S1-2T、SK、α、β和θ)和脊柱骨盆参数(LL和PI)。制作PI、S1-2T、SK、α、β、θ与年龄散点图。比较站立位未成年人与成年人骶骨形态参数差异,并对两组S1-2T、SK、α、β、θ、PI与PI、LL行Pearson相关性分析;比较成年人站立位与仰卧位骶骨形态参数差异,并对两组S1-2T、SK、α、β、θ与LL进行相关性分析并求得θ与LL线性回归方程;控制体位因素变量,比较成年男性与女性骶骨形态参数差异。结果 SK、α、PI随年龄增加而增加,至成年后平稳,SK和α增加约10°,PI增加约20°;S1-2T、θ、β无明显变化;未成年人与成年人骶骨形态参数差异无统计学意义(P>0.05);未成年人PI与LL无相关性(P>0.05),而SK、α、θ与LL有相关性(P<0.05)。不同体位下成年人S1-2T、SK、LL差异有统计学意义(P< 0.05),而α、β、θ差异无统计学意义(P>0.05);站立位和仰卧位时,θ与LL相关性最强,相关系数分别为-0.520、-0.530;仰卧位:LL=-0.3398 × θ + 63.12(r=-0.530),站立位:LL=-0.4509 × θ + 79.45(r=-0.520);同一体位,成年男性与女性骶骨形态参数差异无统计学意义(P>0.05);成年男性由站立位转为仰卧位,S1-2T差异有统计学意义(P<0.05),成年女性由站立位转为仰卧位,S1-2T、SK、α差异有统计学意义(P<0.05)。结论 年龄对于骶骨形态参数影响较小,该参数在未成年人中相比PI与LL相关性更强;α、β、θ不受体位变化影响,不同体位下可通过θ预测LL;相同体位,成年男性与女性骶骨形态参数差异无统计学意义,女性骶骨形态较男性更易受体位改变的影响。Abstract:Background In order to evaluate the sagittal balance of the spine and pelvis, spinal-pelvic imaging parameters have become a research hotspot in recent years, and sacrum morphologic parameters have attracted much attention as a new parameter system. The study of related factors is of great significance to improve the clinical application value of sacrum morphological parameters.Objective To investigate the influence of age, body position, and sex on sacrum morphological parameters.Methods Whole spine radiographs and spine MRI data were collected from the individuals who underwent physical examination in our hospital from January 2013 to December 2020, and sacrum morphological parameters (S1-2T, SK, α, β, and θ) and spinal-pelvic parameters (lumbar lordosis [LL] and pelvic incidence [PI]) were measured for 120 juveniles (in the standing position), 131 adults (in the standing position), and 88 adults (in the supine position). Scatter plots of PI, S1-2T, SK, α, β, θ, and age were generated. Sacrum morphological parameters in the standing position were compared between the juveniles and the adults, and Pearson correlation analysis was performed for S1-2T, SK, α, β, θ, PI, and LL in both groups; sacrum morphological parameters in adults were compared between the standing position and the supine position, correlation analysis was performed for S1-2T, SK, α, β, θ, and LL, and the linear regression equations of θ and LL were obtained. After control for the variable of body position, sacrum morphological parameters were compared between adult male and female individuals.Results SK, α, and PI increased with age and remained stable after an individual became an adult, with SK and α increasing by about 10° and PI increasing by about 20°, while there were no significant changes in S1-2T, θ, and β. There was no significant difference in sacrum morphological parameters between the juveniles and the adults (P>0.05). There was no correlation between PI and LL in the juveniles (P>0.05), but there was a correlation between SK, α, θ and LL (P<0.05). There were significant differences in S1-2T, SK, and LL in the adults in different body positions (P<0.05), while no significant differences were found in α, β, and θ (P>0.05). The correlation between θ and LL was the strongest in the standing position and the supine position, with correlation coefficient of -0.520 and -0.530, respectively. In the supine position, LL=-0.3398× θ + 63.12(r=-0.530), and in the standing position, LL=-0.4509× θ + 79.45(r=-0.520); There were no significant differences in sacrum morphological parameters between the male and female adults in the same body position (P>0.05). In the male adults, there was a significant change in S1-2T from the standing position to the supine position, while in the female adults, there were significant changes in S1-2T, SK, and α from the standing position to the supine position (P<
0.05). Conclusion Age has little influence on sacrum morphological parameters, and the correlation between age and LL is stronger than that between PI and LL in juveniles. α, β, and θ are not affected by the changes in body position, and θ can be used to predict LL in different body positions. There are no significant differences in sacrum parameters between male and female adults in the same body position, and sacrum morphology in female individuals is more easily affected by the change in body position than that in male individuals.-
Keywords:
- sacrum morphologic parameters /
- pelvic incidence /
- lumbar lordosis /
- imaging measurement /
- age /
- position /
- sex
-
骶骨形态参数作为评估脊柱骨盆矢状位序列平衡的新型参数近年来成为脊柱外科领域的研究热点。正常脊柱骨盆矢状位序列具有使脊柱运动自如、承载负荷、缓冲保护器官等作用,一旦失衡,尤其是腰椎前凸角(lumbar lordosis,LL)的丢失,会对人生活质量有重大影响[1-3]。对于矢状位失衡的患者,临床经常使用骨盆入射角(pelvic incidence,PI)来预测患者正常的脊柱骨盆平衡序列,帮助医生制定手术矫正方案。既往研究发现骶骨形态参数与脊柱骨盆矢状位参数存在相关性[4],宋凯等[5]创新性地提出了骶骨后凸角(sacral kyphosis,SK)、骶1-2倾斜角(s1-2 tilt,S1-2T)等新型骶骨形态学参数,该参数系应用更方便且联合PI可得到更精确的LL,为临床重塑脊柱骨盆矢状位序列提供了新的评估方法。为了个性化使用脊柱骨盆矢状位参数,既往研究探讨了年龄、体位等因素对该系列参数的影响[6-7]。为了提高骶骨形态参数的临床应用价值,本研究通过纳入正常骶骨人群(339例)影像学资料进行统计学分析,探讨骶骨形态参数与年龄、体位、性别的关系,为以后不同年龄阶段、不同体位参数、不同性别人群提供了特异性更高的评价方法。
资料与方法
1 研究对象
纳入2013年1月- 2020年12月在解放军总医院第一医学中心行脊柱X线全长片和脊柱核磁影像检查的体检人群(图1)。纳入标准:1)≤35岁;2)脊柱骨盆无冠矢状位失衡;3)X线检查和核磁影像资料完整。排除标准:1)>35岁;2)伴有肿瘤或感染等疾病;3)脊柱病变或畸形、双下肢关节及足畸形;4)腰椎间盘突出、腰椎滑脱、椎间盘缺水变性、影像资料不完整;5)因骶骨未发育完全致使骶骨平台呈圆顶形或不清晰。
图 1 不同骶骨形态X线和核磁影像资料A:未成年人骶骨;B:成年人骶骨;C:成年女性站立位骶骨;D:成年男性站立位骶骨;E:成年女性仰卧位骶骨;F:成年男性仰卧位骶骨Figure 1. X-ray and MRI images of different sacrumA: sacrum of juveniles; B: sacrum of adults; C: standing sacrum female adult; D: standing sacrum of male adult; E: supine sacrum of female adult; F: supine sacrum of male adult2 影像学参数测量
脊柱骨盆参数角:1)LL:骶1上终板的切线与胸12上终板的切线的夹角(图2A);2)PI:骶1上终板中点与双侧髋轴中点连线和骶1上终板垂线的夹角(图2B)。骶骨形态参数角(Ferguson法)[5]:1)S1-2T:标记骶1-2(S1-2)的倾斜线,其与骶1终板垂线的夹角(图2B);2)SK:S1-2倾斜线与骶5尾1(S5Co1)倾斜线的夹角(图2B);3)α角:S2椎体前缘与S4Co1倾斜线夹角;4)β角:S1上终板与S2椎体前缘夹角;5)θ角:S4Co1倾斜线与S1上终板夹角(图2C)。
图 2 脊柱骨盆参数角和骶骨形态参数角的测量A:腰椎前凸角(LL);B:骨盆入射角(PI)、骶1-2倾斜角(S1-2T)、骶骨后凸角(SK);C:S2前缘与S4Co1倾斜线夹角(α),S1上终板与S2前缘夹角(β),S4Co1倾斜线与S1上终板夹角(θ)Figure 2. Measurement of sacral morphology parameters and spino-pelvic parametersA: lumbar lordosis (LL); B: pelvic incidence (PI), S1-2 tilt (S1-2T), Sacral kyphosis (SK); C: the angle between the anterior edge of S2 and S4Co1 tilt (α), the upper endplate of S1 and the anterior edge of S2 (β), S4Co1 tilt and the upper endplate of S1 (θ)3 分析指标
记录三组体检者S1-2T、SK、LL、PI、α、β和θ,仰卧位组不记录PI。制作站立位PI、S1-2T、SK、α、β、θ与年龄散点图,比较未成年人(站立位影像)与成年人(站立位影像)骶骨形态参数差异,分析两组间骶骨形态参数与脊柱骨盆参数的相关性;比较成年人站立位与仰卧位骶骨形态参数差异,分析两组LL与骶骨形态参数的相关性并求得线性回归方程;比较成年男性与女性骶骨形态参数差异。
4 统计学分析
采用SPSS26.0统计学软件对数据进行统计处理。计量资料符合正态分布以
$\bar x \pm s $ 表示,采用独立样本t检验,使用Pearson相关性分析检验参数间相关性,P<0.05为差异有统计学意义。结 果
1 研究对象一般情况
共纳入339例研究对象。未成年人120例(站立位影像),2 ~ 17岁,其中男性55例,平均年龄(9.5±3.5)岁,女性65例,平均年龄(10.3±2.9)岁;成年人131例(站立位影像),其中男性69例,平均年龄(25.7±4.7)岁,女性62例,平均年龄(26.6±4.8)岁;成年人88例(仰卧位影像),其中男性34例,平均年龄(27.4±5.5)岁,女性54例,平均年龄(29.5±4.0)岁。见表1。
表 1 三组体检者一般人口学资料Table 1. Demographic information of the three groupsCharacteristic Juveniles (standing, n=120) Adult (standing, n=131) Adult (supine, n=88) Gender/n Male 55 69 34 Female 65 62 54 Age/yrs 10.3±2.9 26.2±4.8 28.7±4.7 2 年龄与骶骨形态参数的关联性分析
骶骨形态参数、PI、LL与年龄相关散点图如图3所示:SK、α与PI呈相似趋势,在18岁左右前随着年龄增加而增加,成年后基本稳定。PI的变化范围在20°左右,而SK与α变化范围在10°左右,S1-2T、β、θ呈较稳定趋势。基于18岁前后参数变化趋势不同,对未成年人与成年人骶骨形态参数进行比较。规定偏向骶1终板垂线背侧为正值,偏向腹侧为负值。表2显示未成年人与成年人PI差异有统计学意义(P<0.05),而LL、S1-2T、SK、α、β、θ差异无统计学意义(P>0.05)。表3示骶骨形态参数与PI、LL相关性,大部分骶骨形态参数与PI、LL具有相关性,但未成年人PI与LL无相关性。
表 2 未成年人与成年人影像学参数比较(°)Table 2. Comparison of radiological parameters of juveniles and adults (°)Parameter Juveniles (n=120) Adult (n=131) t P S1-2T -15.5±5.6 -15.9±5.3 0.581 0.562 SK 51.6±11.8 50.3±11.9 0.868 0.386 PI 43.9±10.0 46.3±8.5 2.054 0.041 LL 50.3±12.1 50.5±10.9 -0.189 0.843 α 47.5±9.7 46.4±10.5 0.860 0.391 β 68.5±8.2 69.0±7.2 0.514 0.608 θ 64.0±13.0 64.6±12.7 0.370 0.712 图 3 骶骨形态参数与年龄相关散点图A:α与年龄的相关性散点图;B:β与年龄的相关性散点图;C:θ与年龄的相关性散点图;D:SK与年龄的相关性散点图;E:S1-2T与年龄的相关性散点图;F:PI、LL、SK随年龄变化趋势图Figure 3. Correlation between sacral morphology parameters and ageA: correlation between α and age; B: correlation between β and age; C: correlation between θ and age; D: correlation between SK and age; E: correlation between S1-2T and age; F: trend PI, LL and SK with age表 3 未成年人与成年人骶骨形态学参数与PI、LL的Pearson相关性分析Table 3. Pearson correlation analysis between sacral morphology parameters and PI and LL in juveniles and adultsParameter PI LL Juveniles (r) Adult (r) Juveniles (r) Adult (r) PI 1.000 1.000 0.164 0.533a S1-2T 0.578a 0.656a 0.136 0.254a SK 0.440a 0.527a 0.265a 0.432a α 0.374a 0.452a 0.273a 0.396a β 0.641a 0.741a 0.173 0.328a θ -0.683a -0.795a -0.314a -0.515a aP<0.05. 3 成年人体位与骶骨形态参数的关联性分析
如表4所示,S1-2T、α、SK、LL在不同体位差异有统计学意义,且S1-2T、α、SK从站立位转换为仰卧位时均增大,LL因平躺腰前凸角变平而减小。不同体位LL与骶骨参数角的相关性如表5所示,无论站立或仰卧,成人骶骨形态参数均与LL有良好相关性。不同体位线性回归方程,仰卧位:LL=-0.3398 × θ + 63.12(r=-0.530);站立位:LL=-0.4509 × θ + 79.45(r=-0.515)。
表 4 成年人站立位与仰卧位骶骨形态参数比较(°)Table 4. Comparison of sacrum morphologic parameters in adults with standing or supine position (°)Parameter Standing (n=131) Supine (n=88) t P S1-2T -15.9±5.3 -17.9±5.0 2.800 0.006 SK 50.3±11.9 57.5±14.7 3.829 0.000 α 46.4±10.5 49.9±12.5 2.238 0.026 β 69.0±7.2 67.2±6.8 1.854 0.065 θ 64.6±12.7 62.9±15.0 0.902 0.368 LL 50.5±10.9 41.7±9.6 6.127 0.000 表 5 成年人不同体位骶骨形态参数与LL的Pearson相关性分析Table 5. Pearson correlation analysis between sacrum morphologic parameters and LL in adults with standing or supine positionParameter LL (Standing, r) LL (Supine, r) S1-2T 0.254a 0.384a SK 0.432a 0.393a α 0.396a 0.389a β 0.328a 0.451a θ -0.515a -0.530a a P<0.05. 4 性别对骶骨形态参数的影响
表6和表7显示不同性别在同一体位下骶骨形态参数差异无统计学意义。表8和表9中,独立样本t检验结果表明男性SK、α、β、θ不同体位差异无统计学意义,而S1-2T随体位变化而有所改变;女性β、θ不同体位差异无统计学意义,而S1-2T、SK、α差异有统计学意义(P<0.05)。
表 6 仰卧位成年男性与女性骶骨形态学参数比较(°)Table 6. Comparison of sacrum morphologic parameters in supine position between male and female (°)Parameter Male (n=34) Female (n=54) t P S1-2T -17.6±5.4 -18.2±4.7 0.550 0.584 SK 54.9±14.0 59.2±15.0 1.343 0.183 α 48.7±12.6 50.7±12.6 0.725 0.470 β 66.7±7.2 67.4±6.6 0.468 0.641 θ 64.6±15.4 61.9±14.8 0.820 0.414 表 7 站立位成年男性与女性骶骨形态学参数比较(°)Table 7. Comparison of sacrum morphologic parameters in standing position between male and female (°)Parameter Male (n=69) Female (n=62) t P S1-2T -15.6±4.6 -16.3±5.9 0.751 0.454 SK 50.6±12.3 50.0±11.7 0.285 0.776 α 47.4±10.2 45.4±10.8 1.090 0.278 β 69.4±6.4 68.5±7.9 0.719 0.473 θ 63.2±11.9 66.1±13.4 1.312 0.192 表 8 成年男性站立位与仰卧位骶骨形态学参数比较(°)Table 8. Comparison of sacrum morphologic parameters in standing or supine position for male adult (°)Parameter Standing (n=69) Supine (n=34) t P S1-2T -15.6±4.6 -17.6±4.4 2.104 0.038 SK 50.6±12.3 54.9±14.0 1.593 0.114 α 47.4±10.2 48.7±12.6 0.562 0.575 β 69.4±6.4 66.7±7.2 1.931 0.056 θ 63.2±11.9 64.6±15.4 0.508 0.612 表 9 成年女性站立位与仰卧位骶骨形态学参数比较(°)Table 9. Comparison of sacrum morphologic parameters in standing or supine position for female adult (°)Parameter Standing (n=62) Supine (n=54) t P S1-2T -16.3±4.9 -18.2±4.7 2.123 0.036 SK 50.0±11.7 59.2±15.0 3.706 0.000 α 45.4±10.8 50.7±12.6 2.440 0.016 β 68.5±7.9 67.4±6.6 0.807 0.421 θ 66.1±13.4 61.9±14.8 1.604 0.112 讨 论
骶骨在骨骼成熟后,除部分机械病损情况外,基本不会发生形态变化,因此利用骶骨形态参数预测脊柱骨盆矢状位参数得到了脊柱外科领域的重视。既往研究显示PI受年龄等因素影响[7],SK等与PI同属于形态参数,因此我们猜想年龄等因素同样影响骶骨形态参数变化,并证实多种因素与该参数体系之间的某种关系可以帮助临床医生根据不同患者条件实现手术方案个性化,使患者获得更满意的治疗效果。
既往研究中多数学者对年龄是否影响矢状位参数持不同意见[8-9]。本次研究结果显示SK、α、PI与年龄增长趋势相同(图3),在未成年人群中随着年龄增加而增加,到成年后基本恒定,但PI的变化范围在20°左右,而SK和α变化范围在10°左右。有学者认为骶骨形态参数,特别是SK,受生长发育、行走能力的获得、日常姿势、体质量对下腰骶椎的作用力、地面下肢的反作用力等因素长期影响[10-12]。但表2示未成年人与成年人骶骨形态参数差异均无统计学意义,我们认为虽然SK、α在散点图可见有10°变化,但该变化范围较小,因此我们认为骶骨形态参数在发育过程中较PI稳定。为直观发现SK等参数与PI、LL的关系,我们将PI、SK、LL与年龄相关曲线整合(图3F),发现相对于PI,SK与LL整体趋势更接近并且差异更小,尤其在青少年和幼儿年龄段,因此我们猜测未成年人SK等骶骨形态参数与LL之间具有相关性,并且表3结果验证了该想法。但未成年人PI与LL无相关性,这一结果与大多数学者支持的“PI与LL呈正相关”[13]的理论相违背。我们认为未成年人的这种“异常”结果来源于未成年人脊柱骨盆处于发育期并存在生长高峰,未达到成人脊柱骨盆的稳定状态或样本量不足。既往研究纳入人群大多数为成年人,虽有青少年,但年龄结构大多数在15岁及以上,此时骨骼发育高峰期大多数已结束,骨骼发育成熟接近成年人,所以大多数理论趋向PI与LL相关。我们通过纳入幼儿人群发现未成年人骶骨形态参数相较于PI,与LL具有显著相关性,表2和图3显示骶骨形态参数变化差异无统计学意义,因此我们认为年龄对骶骨形态参数影响小,针对本次所有纳入对象,该参数体系适用年龄范围较PI更广泛。
平躺时,腰椎不再支撑躯干及以上结构,垂直面受重力影响使腰椎前凸角减小。如表4所示,仰卧位LL小于站立位LL,这与大部分学者研究结果一致[14-15]。β、θ在站立-仰卧体位中差异无统计学意义,而仰卧位S1-2T、α、SK则较站立位时增加,Abitbol[16]曾通过仰卧实验发现人类骶骨后凸形成与人类仰卧休息姿势有关,且仰卧时间越长,骶骨曲度越大,这可能解释了为何仰卧时S1-2T、α、SK增大。θ与LL的相关性在仰卧位时最强(表5),这与既往研究相似[17]。由站立位转变为仰卧位时,仰卧位时LL-SK的相关性较站立位时减弱,即站立位时骶骨后凸与腰椎前凸的联系更强,侧面说明了腰椎前凸角和骶骨后凸角与人类直立行走能力的获得有很大关系。由线性方程可知,无论是仰卧位抑还是站立位,θ与LL均相关性最强且可预测LL。脊柱外科医生可利用PI、θ对LL进行术前设计,达到更加匹配的腰椎前凸角,从而提高患者术后的生活质量。
男女性骨盆的解剖形态有明显区别。男性骨盆较宽较大,真骨盆上口较窄,呈三角形,骶骨整体较窄;而女性骨盆较短较圆,真骨盆上口较大较圆,骶骨整体较宽,且尾骨较男性活动性更大[18]。我们从成年男性与女性骶骨形态参数对比结果(表6 ~ 表9)中知,虽然不同体位下男女骶骨形态参数差异均无统计学意义,但由站立位转为仰卧位时,女性骶骨参数改变类型多于男性,说明体位导致骶骨形态参数的变化还是受性别影响的。我们认为由于男性雄性激素分泌较多,导致男性骶骨刚性强,所以体位变化对骶骨的形态影响较小;而雌性激素会使骶骨韧性更好,且女性为生育分娩,骶骨曲度较男性更易变化。从解剖学上分析,骶骨后凸是由前方的骶棘韧带、骶结节韧带以及后上方的竖脊肌共同牵拉的结果,男女性骶棘韧带等拉力的不同也可能对骶骨曲度造成影响。相关人员也通过研究证实由于骶髂关节的解剖和受力因素,女性较男性更易发生腰骶段滑脱[19],但这些不同因素归根到底还是受生育因素影响的。由于女性的骶骨参数随体位变化的变化范围较广,脊柱外科医生可能需要为女性脊柱矫形固定患者制定更为紧密的治疗方案,让女性患者达到术后日常站立与平卧舒适度最佳的平衡点。
综上所述,与PI相比,年龄对骶骨形态参数影响较小,该参数体系同样适用于未成年人,不同体位下均可通过θ预测LL,女性骶骨形态参数较男性更易受体位变化影响。因此在获得骨盆入射角等影像学参数困难时,临床可根据不同年龄、性别和体位参考骶骨参数体系评估人体脊柱骨盆矢状位平衡。本研究不足之处:站立位与仰卧位影像学资料无法来自同一个研究对象,虽然通过提高样本量来减少选择偏倚,但未来仍需进行前瞻性研究以消除此误差;本研究年龄局限在35岁以下,因为脊柱疾病多发于中老年人,所以未来需进一步开展对35岁以上人群的骶骨形态参数研究。
-
图 1 不同骶骨形态X线和核磁影像资料
A:未成年人骶骨;B:成年人骶骨;C:成年女性站立位骶骨;D:成年男性站立位骶骨;E:成年女性仰卧位骶骨;F:成年男性仰卧位骶骨
Figure 1. X-ray and MRI images of different sacrum
A: sacrum of juveniles; B: sacrum of adults; C: standing sacrum female adult; D: standing sacrum of male adult; E: supine sacrum of female adult; F: supine sacrum of male adult
图 2 脊柱骨盆参数角和骶骨形态参数角的测量
A:腰椎前凸角(LL);B:骨盆入射角(PI)、骶1-2倾斜角(S1-2T)、骶骨后凸角(SK);C:S2前缘与S4Co1倾斜线夹角(α),S1上终板与S2前缘夹角(β),S4Co1倾斜线与S1上终板夹角(θ)
Figure 2. Measurement of sacral morphology parameters and spino-pelvic parameters
A: lumbar lordosis (LL); B: pelvic incidence (PI), S1-2 tilt (S1-2T), Sacral kyphosis (SK); C: the angle between the anterior edge of S2 and S4Co1 tilt (α), the upper endplate of S1 and the anterior edge of S2 (β), S4Co1 tilt and the upper endplate of S1 (θ)
图 3 骶骨形态参数与年龄相关散点图
A:α与年龄的相关性散点图;B:β与年龄的相关性散点图;C:θ与年龄的相关性散点图;D:SK与年龄的相关性散点图;E:S1-2T与年龄的相关性散点图;F:PI、LL、SK随年龄变化趋势图
Figure 3. Correlation between sacral morphology parameters and age
A: correlation between α and age; B: correlation between β and age; C: correlation between θ and age; D: correlation between SK and age; E: correlation between S1-2T and age; F: trend PI, LL and SK with age
表 1 三组体检者一般人口学资料
Table 1 Demographic information of the three groups
Characteristic Juveniles (standing, n=120) Adult (standing, n=131) Adult (supine, n=88) Gender/n Male 55 69 34 Female 65 62 54 Age/yrs 10.3±2.9 26.2±4.8 28.7±4.7 表 2 未成年人与成年人影像学参数比较(°)
Table 2 Comparison of radiological parameters of juveniles and adults (°)
Parameter Juveniles (n=120) Adult (n=131) t P S1-2T -15.5±5.6 -15.9±5.3 0.581 0.562 SK 51.6±11.8 50.3±11.9 0.868 0.386 PI 43.9±10.0 46.3±8.5 2.054 0.041 LL 50.3±12.1 50.5±10.9 -0.189 0.843 α 47.5±9.7 46.4±10.5 0.860 0.391 β 68.5±8.2 69.0±7.2 0.514 0.608 θ 64.0±13.0 64.6±12.7 0.370 0.712 表 3 未成年人与成年人骶骨形态学参数与PI、LL的Pearson相关性分析
Table 3 Pearson correlation analysis between sacral morphology parameters and PI and LL in juveniles and adults
Parameter PI LL Juveniles (r) Adult (r) Juveniles (r) Adult (r) PI 1.000 1.000 0.164 0.533a S1-2T 0.578a 0.656a 0.136 0.254a SK 0.440a 0.527a 0.265a 0.432a α 0.374a 0.452a 0.273a 0.396a β 0.641a 0.741a 0.173 0.328a θ -0.683a -0.795a -0.314a -0.515a aP<0.05. 表 4 成年人站立位与仰卧位骶骨形态参数比较(°)
Table 4 Comparison of sacrum morphologic parameters in adults with standing or supine position (°)
Parameter Standing (n=131) Supine (n=88) t P S1-2T -15.9±5.3 -17.9±5.0 2.800 0.006 SK 50.3±11.9 57.5±14.7 3.829 0.000 α 46.4±10.5 49.9±12.5 2.238 0.026 β 69.0±7.2 67.2±6.8 1.854 0.065 θ 64.6±12.7 62.9±15.0 0.902 0.368 LL 50.5±10.9 41.7±9.6 6.127 0.000 表 5 成年人不同体位骶骨形态参数与LL的Pearson相关性分析
Table 5 Pearson correlation analysis between sacrum morphologic parameters and LL in adults with standing or supine position
Parameter LL (Standing, r) LL (Supine, r) S1-2T 0.254a 0.384a SK 0.432a 0.393a α 0.396a 0.389a β 0.328a 0.451a θ -0.515a -0.530a a P<0.05. 表 6 仰卧位成年男性与女性骶骨形态学参数比较(°)
Table 6 Comparison of sacrum morphologic parameters in supine position between male and female (°)
Parameter Male (n=34) Female (n=54) t P S1-2T -17.6±5.4 -18.2±4.7 0.550 0.584 SK 54.9±14.0 59.2±15.0 1.343 0.183 α 48.7±12.6 50.7±12.6 0.725 0.470 β 66.7±7.2 67.4±6.6 0.468 0.641 θ 64.6±15.4 61.9±14.8 0.820 0.414 表 7 站立位成年男性与女性骶骨形态学参数比较(°)
Table 7 Comparison of sacrum morphologic parameters in standing position between male and female (°)
Parameter Male (n=69) Female (n=62) t P S1-2T -15.6±4.6 -16.3±5.9 0.751 0.454 SK 50.6±12.3 50.0±11.7 0.285 0.776 α 47.4±10.2 45.4±10.8 1.090 0.278 β 69.4±6.4 68.5±7.9 0.719 0.473 θ 63.2±11.9 66.1±13.4 1.312 0.192 表 8 成年男性站立位与仰卧位骶骨形态学参数比较(°)
Table 8 Comparison of sacrum morphologic parameters in standing or supine position for male adult (°)
Parameter Standing (n=69) Supine (n=34) t P S1-2T -15.6±4.6 -17.6±4.4 2.104 0.038 SK 50.6±12.3 54.9±14.0 1.593 0.114 α 47.4±10.2 48.7±12.6 0.562 0.575 β 69.4±6.4 66.7±7.2 1.931 0.056 θ 63.2±11.9 64.6±15.4 0.508 0.612 表 9 成年女性站立位与仰卧位骶骨形态学参数比较(°)
Table 9 Comparison of sacrum morphologic parameters in standing or supine position for female adult (°)
Parameter Standing (n=62) Supine (n=54) t P S1-2T -16.3±4.9 -18.2±4.7 2.123 0.036 SK 50.0±11.7 59.2±15.0 3.706 0.000 α 45.4±10.8 50.7±12.6 2.440 0.016 β 68.5±7.9 67.4±6.6 0.807 0.421 θ 66.1±13.4 61.9±14.8 1.604 0.112 -
[1] Filiz MB,Firat SC. Effects of physical therapy on pain,functional status,sagittal spinal alignment,and spinal mobility in chronic non-specific low back pain[J]. Eurasian J Med,2019,51(1): 22-26. doi: 10.5152/eurasianjmed.2018.18126
[2] Alanazi MH,Parent EC,Dennett E. Effect of stabilization exercise on back pain,disability and quality of life in adults with scoliosis:a systematic review[J]. Eur J Phys Rehabil Med,2018,54(5): 647-653.
[3] 陈超,崔赓,宋凯,等. Lenke 5型青少年特发性脊柱侧弯患者术后近端交界性后凸与脊柱骨盆参数的相关性[J]. 解放军医学院学报,2019,40(6): 548-553. doi: 10.3969/j.issn.2095-5227.2019.06.011 [4] McKay G,Torrie PA,Dempster G,et al. The relationship between sacral kyphosis and pelvic incidence[J]. Asian Spine J,2018,12(1): 74-79. doi: 10.4184/asj.2018.12.1.74
[5] 宋凯,吴兵,成俊遥,等. 骶骨形态与脊柱骨盆矢状位参数的相关性研究[J]. 中国脊柱脊髓杂志,2020,30(6): 493-499. doi: 10.3969/j.issn.1004-406X.2020.06.03 [6] Park SA,Kwak DS,Cho HJ,et al. Changes of spinopelvic parameters in different positions[J]. Arch Orthop Trauma Surg,2017,137(9): 1223-1232. doi: 10.1007/s00402-017-2757-0
[7] Suzuki H,Endo K,Mizuochi J,et al. Sagittal lumbo-pelvic alignment in the sitting position of elderly persons[J]. J Orthop Sci,2016,21(6): 713-717. doi: 10.1016/j.jos.2016.06.015
[8] 李博,胡文,杨明园,等. 脊柱骨盆矢状面参数随年龄的变化[J]. 第二军医大学学报,2020,41(3): 254-258. doi: 10.16781/j.0258-879x.2020.03.0254 [9] Basu S,Solanki A,Patel D,et al. Normal Spino-pelvic parameters and correlation between lumbar lordosis (LL) and pelvic incidence (PI) in children and adolescents in Indian population[J]. Spine Deform,2021,9(4): 941-948. doi: 10.1007/s43390-020-00280-5
[10] Esteban JM,Martín-Serra A,Varón-González C,et al. Morphological evolution of the carnivoran sacrum[J]. J Anat,2020,237(6): 1087-1102. doi: 10.1111/joa.13272
[11] Been E,Gómez-Olivencia A,Shefi S,et al. Evolution of spinopelvic alignment in hominins[J]. Anat Rec (Hoboken),2017,300(5): 900-911. doi: 10.1002/ar.23559
[12] Cardoso HFV,Pereira V,Rios L. Chronology of fusion of the primary and secondary ossification centers in the human sacrum and age estimation in child and adolescent skeletons[J]. Am J Phys Anthropol,2014,153(2): 214-225. doi: 10.1002/ajpa.22422
[13] Bailey JF,Shefi S,Soudack M,et al. Development of pelvic incidence and lumbar lordosis in children and adolescents[J]. Anat Rec (Hoboken),2019,302(12): 2132-2139. doi: 10.1002/ar.24209
[14] 孙卓然,姜帅,邹达,等. 国人青年人群坐-立位脊柱-骨盆矢状位序列变化研究[J]. 中国脊柱脊髓杂志,2018,28(4): 325-329. doi: 10.3969/j.issn.1004-406X.2018.04.07 [15] 李杰静,郭鸿飞,赵陆,等. 脊柱侧凸患者站立位与平卧位脊柱骨盆矢状面序列差异[J]. 解放军医学院学报,2015,36(6): 603-606. doi: 10.3969/j.issn.2095-5227.2015.06.022 [16] Abitbol MM. Sacral curvature and supine posture[J]. Am J Phys Anthropol,1989,80(3): 379-389. doi: 10.1002/ajpa.1330800311
[17] Chevillotte T,Coudert P,Cawley D,et al. Influence of posture on relationships between pelvic parameters and lumbar lordosis:comparison of the standing,seated,and supine positions. A preliminary study[J]. Orthop Traumatol Surg Res,2018,104(5): 565-568. doi: 10.1016/j.otsr.2018.06.005
[18] DeSilva JM,Rosenberg KR. Anatomy,development,and function of the human pelvis[J]. Anat Rec (Hoboken),2017,300(4): 628-632. doi: 10.1002/ar.23561
[19] 师宁宁,沈国权,郭汝宝,等. 骶骨倾斜移位与L5S1椎间盘退变之间的相关性生物力学分析[J]. 中国骨伤,2017,30(3): 217-221.