学术论文

      青春期骨盆解剖形态变化与骨盆入射角的关系

      Changing pelvic incidence with the anatomical morphology during adolescence

      摘要:
      目的 探讨青春期(骨骼生长高峰期)骨盆入射角(pelvic incidence,PI)的变化规律,以及骨盆、骶骨解剖形态改变与PI的关系.方法 回顾性研究纳入标准为年龄9~18岁的特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者,拍摄全脊柱正、侧位X线片,并至少有3次随访.每次随访时测量PI、骨盆高度(pelvic height,PH)、骨盆宽度(pelvicwidth,PW)、骶骨宽度(sacral width,SW)、股骨头骶骨水平距离(femoral head-sacrum,FH-S)、骶骨弧线长度(sacrum-coccyx length)、骶尾骨距离(sacrum-coccyx distance)和骶骨曲率比(sacrum-coccyx ratio),同时计算△参数和参数变化速率.根据骨骼成熟度分为三组,即低Risser组(初诊为Risser0级,随访包含Risser 0~1级)、中Risser组(初诊为Risser 1级,随访包含Risser 1~3级)和高Risser组(初诊为Risser 3级,随访包含Risser 3~5级),每组均为106例AIS患者;为了观察男女性别的差异,选择性提高了男性的比例.共318例患者,男117例,女201例.按不同性别记录并统计患者的年龄和各测量参数值等计量资料;对观察者内和观察者间进行可靠性分析,计算相关系数(ICC);通过计算Pearson相关系数r值评估△PI和△参数之间的关系.结果 所有患者的平均初诊年龄为12.86岁,初诊Cobb角为26.67°.PI在Risser 1级时增长最快(女性1.5°/年,男性1.6°/年);在Risser 0.5级(女性1.2°/年,男性1.5°/年)和Risser2级(女性1.1°/年,男性1.4°/年)时PI也在迅速增长;当达到骨骼发育减缓的标志Risser 3级时(女性0.9.±0.14°/年,男性1.1°±0.24°/年)PI仍有增长;在Risser4级时(女性0.7°±0.18°/年,男性0.6°±0.13°/年)和Risser 5级时(女性0.6°±0.16°/年,男性0.8°±0.22°/年)增长缓慢.三组的△PI与△年龄呈显著正相关(P<0.05),低Risser组和中Risser组△PI与△年龄的相关性强于高Risser组;△PW与△PI呈显著正相关,低Risser组△PI与△PH呈显著正相关;除去男性低Risser组的△骶骨弧线长度和女性高Risser组的△FH-S外,其余组△SW、△FH-S、△骶骨弧线长度均与△PI呈显著正相关(P<0.05),中Risser组相关性最强;高Risser组男性的骶尾骨距离、骶骨曲率比与△PI无相关性.结论 在9~18岁时骨盆入射角(PI)持续增长,PI在Risser 1级时增长最快,在Risser 5级时仍保持增加潜长;骨盆高度(PH)、股骨头骶骨水平距离(FH-S)、骨盆宽度(PW)和骶骨宽度(SW)与PI增长存在高度相关性.
      Abstract:
      Objective To evaluate the changing pattern of pelvic incidence (PI) during peak skeleton growth in adolescence and to study whether PI is associated with the anatomical morphology changes of pelvis and sacrum.Methods This retrospective longitudinal study recruited adolescent idiopathic scoliosis (AIS) patients,age between 9 and 18 years with full spine images and have at least 3 times' follow-up.The radiological anatomical parameters were measured in each follow-up including PI,pelvic height (PH),pelvic width (PW),sacral width (SW),femoral head-sacrum (FH-S),sacrum-coccyx (S-C) length,sacrum-coccyx (S-C) distance and sacral curvature ratio.△Parameter and growth velocity of each parameters were calculated.According to the skeletal maturity,all subjects were divided into 3 groups:Low Risser Group (first visit at Risser 0 and follow up through Risser 0 to 1),Moderate Risser Group (first visit at Risser 1 and follow up through Risser 1 to 3) and High Risser group (first visit at Risser 3 and follow up through Risser 3 to 5).Each group has 106 patients.We increased the male ratio to detect the gender difference.A total of 318 AIS patients were included in our study and there are 117 male patients.Descriptive analysis was conducted on the sample age,gender and measured parameter values with mean and standard deviation (SD).The intra-and inter-observer reliability analysis,and the intraclass correlation coefficient (ICC) were calculated.The correlation between △PI and △parameter was evaluated by calculating Pearson correlation coefficient R value.Results The mean age of all subjects was 12.86 years and the mean Cobb angle was 26.67° at first visit.The peak growth velocity of PI was in Risser I (female 1.5°/year and male 1.6°/year).The PI was also increasing rapidly in Risser 0.5 (female 1.2°/year and male 1.5°/year) and Risser 2 (female 1.1°/year and male 1.4°/year).When the Risser grade reached 3 which was a sign of the end of skeleton growth,the PI still had increasing potential and it increased slower in Risser 4 and Risser 5.There showed significant correlation between △PI and △age in the three group(P<0.05)and the correlation was stronger in Low Risser group and Moderate Risser group than that in High Risser group.There showed significant correlation between △PW and △PI in all groups while △PH and △PI showed correlation only in Low Risser group.There showed significant correlation between △SW and △PI,△FH-S and △PI,△S-C length and △PI (P<0.05) except △S-C length in male Low Risser group and △FH-S in female High Risser group and the Moderate Risser group had the strongest correlation.The △S-C distance and △S-C ratio didn't show any correlation with △PI (P<0.05) expect the male of High Risser group.Conclusion Pelvic incidence is increasing during skeleton growth at the age of 9 to 17.It has the peak growth velocity in Risser 1 and remains growth potential in Risser 5.PI growth is correlated with pelvic height,femoral head-sacrum distance,pelvic width and sacral width.
      Author: Zhang Yuancheng Bao Hongda Shu Shibin Gu Qi Liu Zhen Zhu Zezhang Qiu Yong
      作者单位: 南京大学医学院附属鼓楼医院脊柱外科 210008
      刊 名: 中华骨科杂志 ISTICPKU
      年,卷(期): 2019, 39(4)
      在线出版日期: 2019年4月25日
      基金项目: 江苏省自然科学基金青年基金(BK20180122)Youth Fund of Natural Science Foundation of Jiangsu Province