| 椎体和椎间盘矢状面形态学改变对退变性脊柱后凸畸形的影响 |
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投稿时间：2022-10-18
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| 作者 | Author | 单位 | Address | E-Mail |
| 何守玉 |
HE Shou-yu |
湖州师范学院附属第一医院脊柱外科, 浙江 湖州 313000 |
Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China |
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| 李海东 |
LI Hai-dong |
湖州师范学院附属第一医院脊柱外科, 浙江 湖州 313000 |
Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China |
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| 闵继康 |
MIN Ji-kang |
湖州师范学院附属第一医院脊柱外科, 浙江 湖州 313000 |
Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China |
mjk@medmail.com |
| 罗盛昌 |
LUO Sheng-chang |
湖州师范学院附属第一医院脊柱外科, 浙江 湖州 313000 |
Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China |
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| 戴季林 |
DAI Ji-lin |
湖州师范学院附属第一医院脊柱外科, 浙江 湖州 313000 |
Spine Surgery, the First Affiliated Hospital of Huzhou Teachers College, Huzhou 313000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2023年，第36卷，第7期，第653-657页 |
| DOI：10.12200/j.issn.1003-0034.2023.07.011 |
| 基金项目:浙江省医药卫生科技计划项目（编号：2020KY941） |
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中文摘要:
目的：探讨椎体楔形变和椎间盘退变（塌陷）等形态学改变对成人退变性胸腰椎/腰椎后凸畸形的影响。
方法：回顾性分析2015年8月至2020年12月收治的32例脊柱退变性胸腰椎/腰椎后凸畸形患者，其中男8例，女24例，年龄48~75（60.3±12.4）岁。在站立位全脊柱正侧位X线片上测量脊柱冠状面侧凸Cobb角和矢状面胸腰椎/腰椎后凸角（kyphosis angle，KA），评估顶椎（apex vertebral，AV）及顶椎上下各2个椎体（AV-1，AV-2，AV+1，AV+2）与椎间盘（AV-1D，AV-2D，AV+1D，AV+2D）的高度及楔变参数，包括椎体前缘高度（anterior vertebral body height，AVH），椎体后缘高度（posterior vertebral body height，PVH），椎体楔变角（vertebral wedge angle，VWA），椎体楔变率（ratio of vertebral wedging，RVW）；椎间盘前缘高度（anterior disc height，ADH），椎间盘后缘高度（posterior disc height，PDH），椎间盘楔变角（disc wedge angle，DWA），椎间盘楔变率（ratio of disc wedging，RDW），椎间盘贡献率（DWA/KA）。
结果：所纳入患者KA为（44.2±19.1）°，后凸节段内椎体前缘高度均显著低于椎体后缘高度（P<0.05），提示椎体发生不同程度楔形变；而后凸节段内椎间盘前后缘高度差异无统计学意义。后凸节段内椎体楔变率/贡献率分别为AV-2（14.98±10.95）%/（14.21±8.08）%，AV-1（21.08±12.39）%/（18.09±7.38）%，AV （26.94±11.94）%/（25.52±8.64）%，AV+1（24.19±8.42）%/（20.82±8.69）%，AV+2（20.56±7.80）%/（15.60±9.71）%，椎体总贡献率为（94.23±22.25）%；后凸节段内椎间盘楔变率/贡献率分别为AV-2D （2.88±2.57）%/（5.27±4.11）%，AV-1D （1.98±1.41）%/（2.29±2.16）%，AV+1D （-5.54±3.75）%/（-0.57±0.46）%，AV+2D （-8.27±4.62）%/（-1.22±1.11）%，椎间盘总贡献率（5.77±4.79）%，且顶椎贡献率明显大于邻近椎体贡献率（P<0.05）。
结论：椎体楔形变及椎间盘塌陷共同构成了成人退变性胸腰椎/腰椎后凸畸形状态。就对后凸贡献率而言，椎体形态改变对后凸的贡献要远超椎间盘的贡献，且顶椎的楔形变对胸腰椎/腰椎后凸的贡献尤为明显。 |
| 【关键词】退变性后凸畸形 胸腰椎 腰椎 椎体楔形变 椎间盘退变 |
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| Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity |
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ABSTRACT
Objective To explore the effects of morphological changes such as vertebral wedge deformation and disc degeneration (collapse) on adult thoracolumbar/lumbar degenerative kyphosis(TL/LDK) deformity.
Methods A retrospective analysis of 32 patients with spinal TL/LDK deformity admitted from August 2015 to December 2020, including 8 males and 24 females, aged 48 to 75(60.3±12.4) years old. On the long-cassette standing upright lateral radiographs, the coronal Cobb angle, sagittal thoracic lumbar/lumbar kyphosis angle(KA) of spine were measured, and the height and wedge parameters of apex vertebral(AV) and two vertebrae(AV-1, AV-2, AV+1, AV+2) above and below AV and the intervertebrae and the intervertebral disc(AV-1D, AV-2D, AV+1D, AV+2D) were evaluated, involving anterior vertebral body height(AVH), posterior vertebral body height(PVH), vertebral wedge angle(VWA), ratio of vertebral wedging(RVW), anterior disc height(ADH), posterior disc height(PDH), disc wedge angle(DWA), ratio of disc wedging(RDW), and DWA/KA.
Results The average angle of kyphosis was (44.2±19.1)°. A significant decrease in anterior height of vertebral was observed compared to the posterior height of vertebral(P<0.005). There was no significant difference in anterior and posterior height of discs. The vertebral wedging ratio/contribution ratio:AV-2(14.98±10.95)%/(14.21±8.08)%, AV-1(21.08±12.39)%/(18.09±7.38)%, AV(26.94±11.94)%/(25.52±8.64)%, AV+1(24.19±8.42)%/(20.82±8.69)%, AV+2(20.56±7.80)%/(15.60±9.71)%, total contribution(94.23±22.25)%, the disc wedging ratio/contribution ratio:AV-2D(2.88±2.57)%/(5.27±4.11)%, AV-1D(1.98±1.41)%/(2.29±2.16)%, AV+1D(-5.54±3.75)%/(-0.57±0.46)%, AV+2D(-8.27±4.62)%/(-1.22±1.11)%, total contribution (5.77±4.79)%. And the contribution rate of AV was significantly higher than that of adjacent vertebral(P<0.05).
Conclusion The vertebral body and intervertebral disc shape both have influence on thoracolumbar kyphosis. However, the contribution of vertebral morphometry to the angle of TL/LDK deformity is relatively more important than the disc. The contribution of the wedge change of the AV to the TL/LDK deformity is particularly significant. |
| KEY WORDS Degenerative kyphosis Thoracolumbar vertebrae Lumbar vertebrae Vertebral wedging Disc degeneration |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 何守玉,李海东,闵继康,罗盛昌,戴季林.椎体和椎间盘矢状面形态学改变对退变性脊柱后凸畸形的影响[J].中国骨伤,2023,36(7):653~657 |
| 英文格式: | HE Shou-yu,LI Hai-dong,MIN Ji-kang,LUO Sheng-chang,DAI Ji-lin.Effect of morphological changes in the sagittal plane of vertebrae and discs on degenerative kyphodeformity[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(7):653~657 |
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