退行性脊柱畸形患者胸腰椎活动度特征分析

李凯; 杨森; 武文杰; 杨乾坤; 魏小雨; 陈灿; 喻学科; 陈春华; 罗飞

doi:10.16016/j.2097-0927.202111074

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退行性脊柱畸形患者胸腰椎活动度特征分析

临床医学 | 更新时间：2026-01-09

- 退行性脊柱畸形患者胸腰椎活动度特征分析
- Characteristics of thoracic and lumbar mobility in patients with degenerative spinal deformity
- 陆军军医大学学报 2022年44卷第6期页码：556-562
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院骨科
  2.453000 河南新乡，中国人民解放军陆军第八十三集团军医院骨科
- 作者简介：
  
  [罗飞，E-mail：luofeispine@126.com LUO Fei, E-mail: luofeispine@126.com
- 基金信息：
  
  军队后勤科研重大项目(AWS17J004)
- DOI：10.16016/j.2097-0927.202111074
  中图分类号： R195.4; R682.13
- 收稿：2021-11-10，
  
  修回：2022-01-05，
  
  纸质出版：2022-03-30
- 稿件说明：
移动端阅览
李凯, 杨森, 武文杰, 等. 退行性脊柱畸形患者胸腰椎活动度特征分析[J]. 陆军军医大学学报, 2022,44(6):556-562.

Kai LI, Sen YANG, Wenjie WU, et al. Characteristics of thoracic and lumbar mobility in patients with degenerative spinal deformity[J]. Journal of Army Medical University, 2022, 44(6): 556-562.
李凯, 杨森, 武文杰, 等. 退行性脊柱畸形患者胸腰椎活动度特征分析[J]. 陆军军医大学学报, 2022,44(6):556-562. DOI： 10.16016/j.2097-0927.202111074.

Kai LI, Sen YANG, Wenjie WU, et al. Characteristics of thoracic and lumbar mobility in patients with degenerative spinal deformity[J]. Journal of Army Medical University, 2022, 44(6): 556-562. DOI： 10.16016/j.2097-0927.202111074.

摘要

目的

探讨退行性脊柱畸形(degenerative spinal deformity，DSD)的胸腰椎三维活动度特征。

方法

于2018年5月至2021年5月在陆军军医大学第一附属医院骨科招募的100例被试者，畸形组60例(均以腰弯方向区分向左侧凸39例，向右侧凸21例)和同期健康体检组40例作为对照组。采用手持关节角度仪测量被试者的胸椎左右侧屈、左右旋转、腰椎前屈后伸、左右侧屈活动度。于站立位拍摄脊柱全长正侧位X线片，测量冠状面Cobb角，确定顶椎位置并做好记录。在胸腰椎脊柱MRI的顶椎横断面T

W1像上测量顶椎旋转度(apical vertebra rotation，AVR)。比较两组被试者在胸腰椎活动度的差异，并在畸形组中分析胸腰椎活动度和AVR以及Cobb角的相关性。

结果

DSD组腰椎冠状面(侧屈)和矢状面(屈伸)的整体活动度、其胸椎在水平面(旋转)的活动度显著小于对照组(

0.01)。左侧弯畸形组的腰椎前屈和后伸、右侧屈(凹侧)及胸椎左旋转(凹侧)右旋转(凸侧)均显著低于对照组(

0.05)。右侧弯畸形组中，腰椎后伸、左侧屈(凹侧)、右侧屈(凸侧)以及胸椎左旋转(凹侧)、右旋转(凸侧)显著低于对照组(

0.05)。在畸形组中，腰椎凸侧侧屈活动度与Cobb角(

=-0.282，

=0.035)和AVR(

=-0.343，

=0.010)均呈显著负相关。

结论

DSD在各方向上均存在一定的脊柱活动度受限，在腰椎上主要以前屈后伸和侧屈受限为主，在胸椎上以旋转受限为主；腰椎凸侧侧屈活动度和AVR与Cobb角密切相关。

Abstract

Objective

To explore the characteristics of thoracic and lumbar mobility in patients with degenerative spine deformity (DSD).

Methods

A total of 60 patients with degenerative spine deformity (DSD) admitted in our hospital from M

ay 2018 to May 2021 were recruited in the study

and another 40 healthy individuals who taking physical examination during same period served as control group. The patients including 39 cases of scoliosis convex to the left and 21 cases to the right. A handheld joint actiometer was used to measure thoracic vertebrae left-right lateral flexion

left-right rotation

and lumbar vertebrae flexion and extension

left and right lateral flexion in the deformed group and control group. The parameters

including coronal Cobh angle (CA) and apical vertebra (AV) were measured on the X-ray films of the whole spine in the standing position. The apical vertebra rotation (AVR) was measured on the cross-sectional T

W1 image of MRI. Differences in thoracic and lumbar vertebrae range of motion (ROM) were compared between the 2 groups

and the correlation of thoracic and lumbar vertebrae ROM with AVR and CA angle were analyzed in the deformed group.

Results

The overall ROM of the lumbar lateral flexion

flexion

extension and the ROM of the thoracic vertebra rotation were significantly smaller than those of the control group (

0.01). In the left-sided curved deformities

the lumbar flexion

extension

lateral flexion (concave) and thoracic rotation (concave

convex) were significantly smaller than those in the control group (

0.05). In the right-sided curved deformities

the lumbar extension

lumbar flexion (concave

convex)

and thoracic rotation (concave

convex) were significantly small than in the control group (

0.05). In the deformed group

the lumbar lateral flexion (convex) was significantly negatively correlated with both CA angle (

=-0.282

=0.035) and AVR (

=-0.343

=0.010).

Conclusion

DSD patients have limitations in spinal mobility in all directions. The mobility limitation for lumbar spine mainly focuses on flexion and extension (sagittal plane) and lateral flexion (coronal plane)

while mobility limitation for thoracic vertebrae mainly concentrates on rotation. The lateral flexion mobility on the convex side are closely associated with the Cobb angle and AVR.

关键词

Keywords

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