目的

随着老龄化进程，退变性脊柱畸形的发病率不断增高。然而关于退变性脊柱畸形对患者全身的影响，特别是腹腔的影响尚未明确，本研究通过影像学检查测量退变性脊柱畸形患者与无脊柱畸形患者的腹腔变化以探讨不同畸形类型和畸形程度对腹腔变化的影响。

方法

纳入退变性脊柱畸形患者95例作为畸形组，无脊柱畸形拟行手术的腰椎管狭窄患者100例作为对照组；根据畸形类型分为侧凸组、后凸组、侧后凸组三亚组。收集MRI和（或）CT资料，通过测量轴位腹腔的前后径，左右径及矢状位上的腹腔纵经计算腹腔容积；在矢状位上测量膈肌的旋转角度和剑突-脊柱距离。在脊柱全长X线正侧位获得侧凸角度（Cobb）、胸椎后凸角度（TK）、胸腰椎后凸角度（TLK）和腰椎前凸角度（LL）。

结果

与对照组相比，侧凸组和侧后凸组的腹腔容积明显更小（P<0.01），侧凸组的剑突-脊柱距离更短（P<0.05），后凸组和侧后凸组的膈肌旋转角度明显更小（P<0.01）；

2、组间分析中，侧凸组和侧后凸组的腹腔容积和剑突-脊柱最短距离明显小于后凸组，后凸组和侧后凸组的膈肌旋转角明显小于侧凸组；3、多重线性回归分析可以得到影响腹腔变化的因素：腹腔容积（ACV） = - 27.17×Cobb + 58.2×体重 + 2231.821（R²=0.63，P<0.001），剑突-脊柱最短距离（TSD） = 0.03×TLK +0.08×体重 + 4.95（R²=0.32，P<0.05），膈肌旋转角（DR）= - 0.12 × TLK + 25.82（R²= 0.1，P<0.05）。

结论

退变性脊柱侧（后）凸畸形患者的腹腔容积较无畸形者更小，且与侧凸程度负相关。这种变化可能会降低患者的日常生活质量，增加围手术期风险；对于重度退变性脊柱侧凸患者，不仅需要密切关注其潜在的腹部并发症，而且行矫形手术或许是必要的。

2、退变性胸腰段后凸患者的腹腔容积无明显变化，但后凸会导致膈肌的旋转，旋转的程度与后凸程度相关；因此对于重度退变性脊柱后凸畸形患者，需要行肺功能检查。

 

Objective

The incidence of degenerative spinal deformity is increasing with the aging process. However, the effect of degenerative spinal deformity on the abdominal cavity is unclear. We use MRI and CT scan to measure the abdominal changes, to explore the effects of different types and degrees of deformities on abdominal changes.

Method

The retrospective study included 95 patients with degenerative spinal deformity and 100 LSS patients without deformity as control group. The MRI and CT data were collected. The abdominal volume was calculated by measuring the longitudinal, transversal and coronal diameters of the abdominal cavity; the rotation of the diaphragm and the xiphoid process-spine distance were measured in the sagittal plane. The scoliosis angle (Cobb), thoracic kyphosis angle (TK), thoracolumbar kyphosis angle (TLK) and lumbar kyphosis angle (LL), were obtained through full-length X-ray. Patients were divided into three subgroups according to the deformity type: scoliosis group, kyphosis group, and scoliokyphosis group.

Result

Compared with the control group, the abdominal volume of the scoliosis group and scoliokyphosis group was significantly smaller. The distance between the xiphoid process and spine in the scoliosis group was significantly shorter, and the rotation angle of the diaphragm in the kyphosis group and scoliokyphosis group was significantly smaller.  The inter-group analysis shows that the abdominal volume and the shortest distance between the xiphoid process and spine in the scoliosis group and scoliokyphosis group were significantly smaller than those in the kyphosis group. The degree of diaphragm rotation in the kyphosis group and the scoliokyphosis group was higher than that in the scoliosis group.  Multiple linear regression analysis: abdominal volume (ACV) =-27.17 × Cobb + 58.2 × body weight + 2231.821 (R2 × 0.63 P<0.001). The rotation angle of diaphragm was (DR) =-0.12 × TLK + 25.82 (R2 = 0.1, P< 0.05). The shortest distance between xiphoid process and spine (TSD) = 0.03 × TLK + 0.08 × body weight + 4.95 (R2 = 0.32, P< 0.05).

Conclusion

The abdominal cavity volume of patients with degenerative scoliosis and scoliokyphosis is smaller than that of normal people, and it is related to the degree of deformity，which may reduce the quality of the patient's daily life and increase the perioperative risk. For patients with severe degenerative scoliosis, surgeons should pay attention to the potential abdominal complications; for patients who already have complications, deformity surgery may be necessary. Degenerative thoracolumbar kyphosis will cause the diaphragm to rotate. The degree of rotation is related to the degree of kyphosis. Therefore, for patients with severe degenerative kyphosis, pulmonary function tests are required to rule out potential abnormalities.

第一章 文献综述 1
1.1退变性脊柱畸形的现状和进展 1
1.2 脊柱畸形与机体功能相关的研究和进展 6
第二章 引言 8
第三章 对象与方法 9
3.1 一般资料 9
3.2影像学测量 9
3.3 统计学分析 12
第四章 结果 14
4.1 一般临床资料 14
4.2 影像学资料 15
4.3 退变性脊柱畸形患者的腹腔变化 16
4.4 退变性脊柱畸形组间腹腔变化的分析 19
4.5 退变性脊柱畸形患者影像学参数与腹腔变化的相关性分析 23
第五章 讨论 28
第六章 结论及展望 33
参考文献 34
附录A 腰腿痛VAS评分标准 41
附录B 腰椎ODI评分标准 42
致谢 44
北京大学学位论文原创性声明和使用授权说明 45
个人简历 46

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