目的 探究正常青少年与青少年特发性脊柱侧凸患者矢状位整体平衡参数差异，分析疾病影响因素。 方法 收集242例青少年全脊柱矢状位X线图像，数据来自三家不同的三级甲等医院，筛选后纳入100例影像资料完整的图像作为研究对象，包括50例正常青少年和50例AIS患者。将图像数据导入Mimics 21.0，测量颈椎Cobb角（Cervical Cobb Angle, CCA）、胸椎后凸角（Thoracic Kyphosis, TK）、腰椎前凸角（Lumbar Lordosis, LL）、胸腰椎后凸角（Thoracolumbar Kyphosis, TLK）、矢状面偏移（Sagittal Vertical Axis, SVA）、脊柱倾斜度（Spinal Tilt, ST）、脊柱-骶骨角（Spinosacral Angle, SSA）、脊柱骨盆角（Spinopelvic Angle, SPA）、T1脊柱骨盆倾斜角（T1 Spinopelvic Inclination, T1-SPI）、T9脊柱骨盆倾斜角（T9 Spinopelvic Inclination, T9-SPI）、T1骨盆角（T1 Pelvic Angle, TPA）、L1脊柱骨盆倾角L1 （Lumbar Pelvic Angle, LPA）、骶骨倾斜角（Sacral Slope, SS）、骨盆投射角（Pelvic Incidence, PI）、骨盆倾斜角（Pelvic tilt, PT）矢状位形态学参数，比较正常青少年与AIS患者各参数及AIS患者不同性别之间的差异，比较各指标之间的相关性；二元Logistic回归分析矢状位形态学参数与疾病的关系。 结果 对比正常青少年与AIS患者矢状位参数显示TK、LL、PT、PI、SVA、SSA、SPA、T9-SPI（Z=-3.712，P=0.000；t=16.648，P=0.000；Z=-2.203，P=0.028；Z=-2.147，P=0.032；Z=-3.812，P=0.000；Z=-3.381，P=0.001；Z=-3.723，P=0.000；Z=-3.550，P=0.000）具有统计学意义，其余均无统计学意义（P>0.05）；AIS患者性别间TK、LL、SS、SVA、ST、SPA、T9-SPI具有统计学意义（Z=-2.367，P=0.018；t=6.317，P=0.015；t=6.480，P=0.014；Z=-2.319，P=0.020；Z=-2.377，P=0.017；Z=-2.843，P=0.004；Z=-2.464，P=0.014）；其余均无统计学意义（P>0.05）。AIS患者各矢状位参数显示TK与LL呈弱正相关（r=0.282，P=0.047），与SVA呈显著正相关（r=0.641，P=0.000），与TLK呈弱负相关（r=-0.326，P=0.021）；LL与SS呈显著正相关（r=0.772，P=0.000），与PI呈中等正相关（r=0.435，P=0.002），与SPA呈弱正相关（r=0.324，P=0.022）；PT与PI呈中等正相关（r=0.508，P=0.000）；SS与PI呈中等正相关（r=0.548，P=0.000），与SPA呈弱正相关（r=0.289，P=0.042）；SVA与SSA呈弱正相关（r=0.313，P=0.027），与TLK、T9-SPI呈弱负相关（r=-0.324，P=0.022；r=-0.299，P=0.035）；ST与SPA呈显著正相关（r=0.744，P=0.000）；LPA与TPA呈中等正相关（r=0.5，P=0.000），与T9-SPI呈弱负相关（r=-0.33，P=0.019）。二元Logistic回归分析显示TK、LL、SSA、SPA、T9-SPI具有统计学意义（P=0.007；P=0.025；P=0.005；P=0.012；P=0.018）；其余均无统计学意义（P>0.05）。 结论 AIS患者的TK、LL、SSA、SPA显著增大，T9-SPI显著减小，表明AIS会导致脊柱整体倾斜度增加，并伴随椎体节段性曲度及骨盆形态的改变。因此，术前评估中应重点关注上述参数的变化，以全面掌握脊柱-骨盆整体平衡状态，为制定个体化治疗方案提供参考。
Abstract
Objective To explore the differences in sagittal balance parameters between normal adolescents and adolescent idiopathic scoliosis, and to analyze the influencing factors of the disease. Methods A total of 242 full-spine sagittal X-ray images of adolescents were collected from three different tertiary hospitals. After screening, 100 images with complete imaging data were included in the study, comprising 50 healthy adolescents and 50 patients with adolescent idiopathic scoliosis (AIS). The imaging data were imported into Mimics 21.0 for the measurement of sagittal morphological parameters, including cervical Cobb Angle (CCA), Thoracic Kyphosis (TK), Lumbar Lordosis (LL), Thoracolumbar Kyphosis (TLK), Sagittal Vertical Axis (SVA), Spinal Tilt (ST), Spinosacral Angle (SSA), Spinopelvic Angle (SPA), T1 Spinopelvic Inclination (T1-SPI), T9 Spinopelvic Inclination (T9-SPI), T1 Pelvic Angle (TPA), Lumbar Pelvic Angle (LPA), Sacral Slope (SS), Pelvic Incidence (PI), and Pelvic Tilt (PT). Differences in these parameters were compared between healthy adolescents and AIS patients, as well as between male and female AIS patients. Correlations among parameters were also analyzed. Binary logistic regression analysis was performed to investigate the association between sagittal morphological parameters and the presence of AIS. Results Comparing the sagittal parameters between healthy adolescents and AIS patients showed statistically significant differences in TK, LL, PT, PI, SVA, SSA, SPA, and T9-SPI (Z=-3.712, P=0.000; t=16.648, P=0.000; Z=-2.203, P=0.028; Z= -2.147, P=0.032; Z=-3.812, P=0.000; Z=-3.381, P=0.001; Z=-3.723, P=0.000; Z=-3.550, P=0.000), while the remaining parameters showed no statistical significance (P>0.05). Comparing the gender differences within AIS patients, TK, LL, SS, SVA, ST, SPA, and T9-SPI showed statistically significant differences (Z=-2.367, P=0.018; t=6.317, P=0.015; t=6.480, P=0.014; Z=-2.319, P=0.020; Z=-2.377, P=0.017; Z=-2.843, P=0.004; Z=-2.464, P=0.014), while the remaining parameters showed no statistical significance (P>0.05). In AIS patients, the sagittal parameters showed that TK was weakly positively correlated with LL (r=0.282, P=0.047), significantly positively correlated with SVA (r=0.641, P=0.000), and weakly negatively correlated with TLK (r=-0.326, P=0.021). LL was significantly positively correlated with SS (r=0.772, P=0.000), moderately positively correlated with PI (r=0.435, P=0.002), and weakly positively correlated with SPA (r=0.324, P=0.022). PT was moderately positively correlated with PI (r=0.508, P=0.000). SS was moderately positively correlated with PI (r=0.548, P=0.000) and weakly positively correlated with SPA (r=0.289, P=0.042). SVA was weakly positively correlated with SSA (r=0.313, P=0.027) and weakly negatively correlated with TLK and T9-SPI (r=-0.324, P=0.022; r=-0.299, P=0.035). ST was significantly positively correlated with SPA (r=0.744, P=0.000). LPA was moderately positively correlated with TPA (r=0.5, P=0.000) and weakly negatively correlated with T9-SPI (r=-0.33, P=0.019). Binary logistic regression analysis revealed that there were statistically significant in TK, LL, SSA, SPA, and T9-SPI (P=0.007; P=0.025; P=0.005; P=0.012; P=0.018), while the remaining parameters showed no statistical significance (P>0.05). Conclusions In patients with AIS, TK, LL, SSA, and SPA were significantly increased, and T9-SPI was significantly decreased, indicating that AIS may lead to an increase in the overall inclination of the spine, accompanied by changes in the segmental curvature of the vertebral body and pelvic morphology. Therefore, the changes of the above parameters should be focused on in the preoperative evaluation, so as to fully grasp the overall balance of the spine and pelvis, and provide a reference for the formulation of individualized treatment plans.
关键词
青少年特发性脊柱侧凸 /
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矢状位 /
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脊柱-骨盆参数 /
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相关性分析 /
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Logistic回归分析
Key words
Adolescent idiopathic scoliosis /
Sagittal position /
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Spine-pelvic parameters /
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Correlation analysis /
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Logistic regression analysis
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基金
内蒙古自治区“草原英才”工程青年创新创业人才项目（2020）；2021年内蒙古自治区蒙医药协同创新中心科学研究项目（MYYXTYB202104）；内蒙古医科大学2021年度校级科研重点项目（YKD2021ZD001）；内蒙古教育厅高等学校创新团队发展计划（NMGIRT2227）；2022年“草原英才”工程；内蒙古自治区2023年自治区重点研发和成果转化计划（科技支撑黄河流域生态保护和高质量发展）项目（2023YFHH0003）；内蒙古自治区高等学校创新团队发展计划（NMGIRT2419）
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