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目的：基于腰椎曲线类型研究腰椎间盘突出（Lumbar disc herniation，LDH）病人脊柱骨盆矢状序列参数的特点。方法：回顾我院2009 年1 月年至2014 年11 月收治的相邻节段健康的LDH 病人166 例，与141 例健康志愿者对照。按照腰椎类型分为4 型， LDH按照严重程度分为腰4-5 (A)组，腰5-骶1(B)组，腰4-5 和腰5- 骶1 (C)组，三节段以上(D)组。应用图形分析软件进行参数测量，在站立位全长脊柱侧位X 线片上测量参数包括：骨盆投射角（Pelvic incidence, PI）、骨盆倾斜角（Pelvic tilt, PT）和骶骨倾斜角（Sacral slope, SS），胸椎后凸角（Thoracic Kyphosis, TK）、腰椎前凸角（Lumbar lordosis, LL）、上半圆（UP arc）、下半圆（Low arc）、矢状面垂直轴（Sagittal vertical axis SVA），对上述指标统计分析。结果：LDH 组与对照组相比PI、PT 和TK增大，SVA向前移位，SS、 LL 和Up arc减低具有显著统计学差异。LDH 组各参数Pearson 相关性分析示PI~PT，PI~SS 和SS~LL高度相关。LDH病例4 组间参数单因素方差分析无统计学意义，SS、LL和TK 随着突出节段的增加而减小；A 组与对照组比较PI和PT 差异显著。1 型和2 型与相对应的对照组比较，各参数差异显著。结论：相邻节段健康的LDH 病人具有大的PI和PT，小的LL 和SS，SVA向前倾斜，随着病变节段的增加LL,SS和TK 减小；脊柱- 骨盆协调平衡的能力受腰椎类型影响。

英文摘要:

Objective:To evaluate the sagittal spino-pelvic alignment in lumbar disc herniation (LDH) patients compared with normal population according to lumbar types.Methods:Between January 2009 and November 2014, 166 patients with LDH of adjacent segments health were collected, 141 health volunteer were selected as the normal controls. The LDH patients and normal volunteer were divided into 4 types according to the types of lumbar，The different segments pathological changes of lumber were divided into four group:L4-5 (A)group, L5-1 (B)group,L4-5 and L5-S1 (C)group, more than two (D)group. On standing lateral X-ray, the following parameters were measured: pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), lumbar lordosis (LL), UP arc, Low arc ,thoracic kyphosis (TK), sagittal vertical axis (SVA), using Graphical analysis software (Surgimapspine). Sagittal spino-pelvic parameters were analyzed and compared.Results:The average LL, Up arc and SS was smaller in LDH group than normal controls respectively. However, the average PI, PT and SVA of LDH group was higher than normal controls. There was no significant difference between male and female. There is a strong correlation between PI and PT, PI and SS, SS and LL in LDH group by Pearson’s correlation coef cients, as well as normal controls. There was no significant difference in Sagittal spino-pelvic parameters between A, B, C and D group compared with each other by one-way ANOVA test. But the SS, LL and TK decreases accompany with the increase of pathological changes segments. The PI was significant increase in A group compared with normal controls, no significant difference in B, C and D group. The Sagittal spino-pelvic parameters of type of 1 and 2 was significant difference between LDH and controls.Conclusion:The Sagittal spino-pelvic parameters of the LDH patients with healthy adjacent segments was large PI and PT, the small LL and SS, SVA tilted forward. The SS, LL and TK decreases accompany with the increase of pathological segments. The function of maintain lumber balance can be influenced by the Type of lumbar.

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