背景：成人脊柱侧弯患者健康生活状态的相关评价与患者的放射学参数结合，以此来指导外科手术并预测治疗结果，而这些放射学参数是如何影响成人脊柱侧弯治疗结果的目前尚无报道。n 目的：评价成人脊柱侧弯患者手术前后放射学参数变化与健康生活状况的相关性。n 方法：回顾性分析2008年7月至2010年7月收治的68例成人脊柱侧弯患者，男18例，女50例；年龄20-88岁，平均58.5岁。所有患者术前和末次随访时均拍摄全脊柱站立前后位和侧位 X 射线片并采集完整的 ODI调查表。测量患者的放射学参数包括重力线、C7铅垂线、Cobb 角、腰椎前凸角、冠状面侧方滑脱的距离、骨盆入射角、骶骨倾斜角和骨盆倾斜角。分析放射学参数和ODI值的相关性使用Pearson’s 相关分析。n 结果与结论：随访时间6-14个月。患者ODI值术前50.6±16.8，术后41.1±19.6，差异有显著性意义(P ≤0.001)。Cobb角的平均值术前26°，术后10.7°；侧方移位距离平均值术前4.9 mm，术后接近0 mm。矢状面上，术前和术后C7铅垂线与ODI值之间有明显相关性，术后重力线数值和ODI值之间有相关性。冠状面上，术前Cobb角和术后腰椎前凸角与ODI数值之间有相关性。骨盆倾斜角的改变和骶骨倾斜角相等，而骨盆入射角在术后没有变化。提示评价脊柱平衡和患者健康生活状态的相关性，使用重力线并不优于C7铅垂线。患者术后放射学参数的改善并不预示着症状的缓解。骶骨倾斜角角度的丢失和骨盆的后倾在成人脊柱侧弯中更加常见，通过手术并不能明显的改变骶骨倾斜角、骨盆的后倾、腰椎前凸以及脊柱的矢状面平衡。%BACKGROUND:Radiographic parameters have been incorporated with healthy living status in adult scoliosis patients to guide surgery and predict treatment outcome. However, few studies presented how these radiographic parameters influence treatment outcome in adult scoliosis. n OBJECTIVE:To evaluate the correlation between changes in radiographic parameters and healthy living status in adult scoliosis patients before and after surgery. n METHODS:A total of 68 patients with adult scoliosis, who were treated between July 2008 and July 2010, were retrospectively analyzed. There were 18 males and 50 females, at the age of 20 to 88 years old, averagely 58.5 years. Before surgery and during final folow-up, al patients were photographed at posteroanterior and lateral positions using X-ray. Complete Oswestry Disability Index data were colected. Measurements included gravity line, C7 plumb line, Cobb angle, lumbar lordosis, slippage distance on coronal side, pelvic angle of incidence, sacral inclination angle and pelvic tilt angle. Correlation of radiological parameters and Oswestry Disability Index values was analyzed using Pearson’s correlation analysis. n RESULTS AND CONCLUSION:Folow-up lasted 6 to 14 months. Significant differences in Oswestry Disability Index score were visible between preoperation (50.6±16.8) and postoperation (41.1±19.6) (P≤ 0.001). Mean Cobb angle was reduced from 26° preoperatively to 10.7° postoperatively. Lateral olisthesis was reduced from 4.9 mm to almost zero in most patients. On the sagittal plane, C7plumb line was significantly correlated to Oswestry Disability Index score both preoperatively and postoperatively. On the coronal plane, preoperative Cobb angle and postoperative lumbar lordosis were correlated to Oswestry Disability Index. Pelvic tilt angle change was equal to sacral inclination angle. No changes in pelvic incidence angle were found after the surgery. These data indicated spinal balance was correlated with healthy living status. Gravity line was not better than C7 plumb line. The improvement of the radiographic parameters did not predict the relief of symptoms. Lost sacral slope and retroverted pelvis were commonly seen in adult scoliosis. Surgical treatment could not significantly change sacral slope, retroverted pelvis, lumbar lordosis and sagittal balance.
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