臨床整形外科50巻11号

2015年11月発行

誌上シンポジウム 成人脊柱変形へのアプローチ

手術で目指すべきアライメントとは—PI-LLの検証から目指すべき腰椎前弯を探る

著者： 稲見聡¹ 森平泰¹ 竹内大作¹ 司馬洋¹ 大江真人¹ 浅野太志¹ 野原裕¹ 種市洋¹

所属機関： ¹獨協医科大学医学部整形外科学

ページ範囲：P.1065 - P.1068

　PI(pelvic incidence)-LL(lumbar lordosis)＜10°が腰椎前弯形成の指標として広く用いられているが，本研究ではPIの値に応じたPI-LLの理想値を検証した．成人脊柱変形手術後2年以上経過し術後成績の良好な36例を対象とし，PIとPI-LLの関係を回帰分析で解析するとPI-LL＝0.41PI-11.12(r＝0.45，p＝0.0059)の式が得られた．この式から，例えばPI＝30°ではPI-LLは1°であり，PI＝80°ではPI-LLは22°となる．理想的なPI-LLの値は一定の値ではなく，PIによって変化することが示された．

参考文献

1) Berthonnaud E, Dimnet J, Roussouly P, et al:Analysis of the sagittal balance of the spine and pelvis using shape and orientation parameters. J Spinal Disord Tech 18:40-47, 2005

2) Boissiere L, Bourghli A, Vital JM, et al:The lumbar lordosis index:a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339-1345, 2013

3) Boulay C, Tardieu C, Hecquet J, et al:Sagittal alignment of spine and pelvis regulated by pelvic incidence:standard values and prediction of lordosis. Eur Spine J 15:415-422, 2006

4) Duval-Beaupère G, Schmidt C, Cosson P:A Barycentremetric study of the sagittal shape of spine and pelvis:The conditions required for an economic standing position. Ann Biomed Eng 20:451-462, 1992

5) Glassman SD, Bridwell K, Dimar JR, et al:The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024-2029, 2005

6) Horton WC, Brown CW, Bridwell KH, et al:Is there an optimal patient stance for obtaining a lateral 36" radiograph? A critical comparison of three techniques. Spine 30:427-433, 2005

7) Lafage V, Schwab F, Patel A, et al:Pelvic tilt and truncal inclination:two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599-606, 2009

8) Lafage V, Schwab F, Vira S, et al:Spino-pelvic parameter after surgery can be predicted. Spine 36:1037-1045, 2011

9) Le Huec JC, Aunoble S, Philippe L, et al:Pelvic parameters:origin and significance. Eur Spine J 20:S564-S571, 2011

10) Legaye J, Duval-Beaupère G, Hecquet J, et al:Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99-103, 1998

11) Legaye J, Duval-Beauere G:Sagittal plane alignment of the spine and gravity:a radiological and clinical evaluation. Acta Orthop Belg 71:213-220, 2005

12) Protopsaltis T, Schwab F, Bronsard N, et al:The T1 pelvic angle, a novel radiographic measure of global sagittal deformity, accounts for both spinal inclination and pelvic tilt and correlates with health-related quality of life. J Bone Joint Surg Am 96:1631-1640, 2014

13) Rose PS, Bridwell KH, Lenke LG, et al:Role of pelvic incidence, thoracic kyphosis, and patient factors on sagittal plane correction following pedicle subtraction osteotomy. Spine 34:785-791, 2009

14) Roussouly P, Gollogly S, Noseda O, et al:The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line:a radiographic study of the sagittal alignment of the 153 asymptomatic volunteers. Spine 31:E320-E325, 2006

15) Roussouly P, Pinherio-Franco JL:Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J 20:S609-S618, 2011

16) Schwab F, Farcy JP, Bridwell K, et al:A clinical impact classification of scoliosis in the adult. Spine 31:2109-2114, 2006

17) Schwab F, Ungar B, Blondel B, et al:Scoliosis Research Society-Schwab adult spinal deformity classification:a validation study. Spine 37:1077-1082, 2012

18) Schwab F, Patel A, Ungar B, et al:Adult spinal deformity-postoperative standing imbalance:How much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224-2231, 2010

19) Schwab F, Blondel B, Bess S, et al:Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity. Spine 38:E803-E812, 2013

20) 大和　雄，長谷川智彦，小林　祥・他：成人脊柱変形の手術時目標とすべき腰椎前弯角は？—骨盤後継を改善するformulaの作成．J Spine Res 6：449，2015