Journal of the Korean Orthopaedic Association (대한정형외과학회지)

Korean Orthopaedic Association (대한정형외과학회)
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Significance of Pelvic Incidence in the Development of Abnormal Sagittal Alignment

이상 척추 시상 만곡의 발현에 있어서 Pelvic Incidence가 가지는 의의 - 전향적 연구 -

Lee, Chong-Suh;Chung, Sung-Soo;Chung, Kwang-Hoon;Kim, Sang-Rim
이종서;정성수;정광훈;김상림

  • Published : 20060000
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Abstract

Purpose : Under the assumption that the pelvic incidence influences the development of an abnormal curvature, this study examined the relationship between the pelvic incidence and the development of an abnormal curvature. Materials and Methods : Twenty-two adults with a normal curvature and seventy-nine adults with ban abnormal curvature were enrolled in this study. All subjects were older than fifty years of age at the time of the study. The patients were classified based on the alignment of the spine and the strategic vertebrae as follows: extension of the lordosis of the lumbar spine to the upper part of the thoracolumbar transitional portion (Group 1), kyphosis on the lower lumbar area but an extension of the lordosis from the upper lumbar area to the upper part of the thoracolumbar transitional portion (Group 2), extension of the kyphosis from the thoracic spine to the lower lumbar area (Group 3), the presence of lordosis on the lower lumbar portion but an extension of the kyphosis from the upper lumbar portion to the upper portion of the thoracolumbar area (Group 4). In each group, the interrelationship between the sagittal alignment, pelvic tilt, sacral slope and pelvic incidence were evaluated, and the changes in the numerical figures were compared and analyzed. Results : In the normal group the average pelvic incidence was 52.5 degrees. The average pelvic incidence was higher in groups 1 and 2 (61.6 and 58.5 degrees, respectively) than in groups 3 and 4 (44.5 and 47.2 degrees, respectively) (p＜0.001). The average sacral slope was 31.5 in the normal group, 34.5 in group 1, 25.1 in group 4, 20.1 in group 2, and 9.2 in group 3. In groups 1 and 2, group 2 showed a lower sacral slope compared with group 1 (p＜0.001). In groups 3 and 4, group 4 had a larger sacral slope than group 3 (p＜0.001). The average pelvic tilt was 21 in the normal group. Groups 2 and 3 showed a larger pelvic tilt (38.4 and 35.3, respectively) than that of groups 1 and 4 (27.1 and 22.1, respectively). Conclusion : In the elderly with an abnormal lordotic curve, the sagittal alignment of the spine is associated with the pelvic tilt, sacral slope and pelvic incidence, in a similar manner to that in normal adults with a normal lordotic curve. Therefore, measuring these figureswould help in making an estimate of the perspective changes in the sagittal alignment of spine.

목 적: Pelvic incidence에 의해 정해진 시상 만곡의 형태가 향후 연령이 증가하면서 나타나게 되는 이상 만곡의 발현에 어떠한 영향을 미치는지에 대하여 알아 보고자 하였다. 대상 및 방법: 비정상적인 척추 시상 만곡을 지닌 50세 이상의 한국 성인 79명과 정상 척추 시상 만곡을 보이는 50세 이상의 한국 성인 22명을 대상으로 하였다. 이상 만곡의 형태는 척추의 시상면상 정렬 및 전략 추체에 따라 요추부의 전만이 흉요추 이행부 상부까지 연장된 그룹(제1군), 하요추부에는 후만이 존재하지만 전만이 상요추부에서 흉요추 이행부 상부까지 연장되는 그룹(제2군), 흉추부의 후만이 하요추까지 연장된 그룹(제3군), 흉추부의 후만이 상요추부까지 연장되고 하요추부에 전만이 남아 있는 그룹(제4군), 네 군으로 나누어 각각의 군에서 천추 경사, 골반 기울기(천추-골반 각) 및 pelvic incidence를 측정하여 각 군 간 지표의 차이를 비교 분석하였다. 결 과: Pelvic incidence는 상요추부 이상에서 전만의 형태를 보이는 제1, 2군(61.6도, 58.5도)에서는 정상군 (52.5도)보다 컸으며(p＜0.001), 후만의 형태를 보이는 제3, 4군(44.5도, 47.2도)은 정상군보다 작았다(p＜0.001). 천추 경사는 정상군에서는 31.5도였으며 제1군에서는 34.5도, 제4군에서는 25.1도, 제2군에서는 20.1도, 제3군에서는 9.2도 순이었으며, 제1, 2군 중 하요추부에서 후만으로 바뀌는 제2군이 전만을 유지하는 제1군에 비하여 작았고(p＜0.001), 제3, 4군 중 하요추부에서 전만으로 바뀌는 제4군이 후만을 유지하는 제3군보다 컸다(p＜0.001). 골반 기울기는 제2, 3군(38.4도, 35.3도)이 제1, 4군(27.1도, 22.1도)보다 컸으며(p＜0.001), 정상군 (21도)은 제1, 4군보다 작았다(p＜0.001). 결 론: Pelvic incidence는 노년층에서 이상 시상 만곡의 발현에 중요한 역할을 하는 인자 중 하나로 생각되며, 이들 지표의 측정이 향후 척추 시상 정렬의 변화를 어느 정도 예측할 수 있게 해 줄 수 있을 것으로 생각한다.

Keywords

References

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