無症狀亞洲成年人腰椎矢狀排列及骨盆入射角的定量評估

Abstract

脊椎是人體的主要支撐結構,對健康扮演關鍵角色。儘管全球研究者已對骨盆與腰椎矢狀面排列的關係進行諸多研究，但因種族差異，這些數據並不能直接作為台灣的醫療參考依據。本研究提出三項主要創新：首次針對亞洲族群將骨盆入射角(PI)分為三組且各組人數接近1:1:1的全面性研究、首次確認腰椎關鍵分區位置，以及建立專屬亞洲族群的PI與腰椎前凸相關模型。 本研究包含兩個互補部份。首先,我們對324位無症狀亞洲成年人進行前瞻性分析，檢視腰椎矢狀面排列與PI的關係。其次，我們系統性回顧了四篇超過100位無症狀成年人的大型研究，透過腰椎矢狀排列與骨盆入射角的趨勢性變化，以確定最佳腰椎分區位置。 研究結果顯示PI分組（G1：小於45度；G2：介於45-55度之間；G3：大於55度）與腰椎節段性前凸具有明確相關性。近端前凸值在G1、G2、G3組分別為11.6° ± 6.7°、16° ± 7.7°與20.7° ± 8°，而遠端前凸值則分別為30.7° ± 8.1°、34.9° ± 7.9°與37° ± 9.3°。此外，我們發現L3-L4與L4-L5之間存在關鍵生物力學轉換區，並證實了亞洲族群特有的腰椎前凸分布模式。這些發現為脊椎手術之術前規劃、病理狀態之評估，以及族群特異性治療策略的發展提供重要參考依據。本研究結果對於理解亞洲族群特有的脊椎排列模式具有重要的臨床參考價值。

The spine is the main structural support of the human body and plays a crucial role in overall health Although researchers worldwide have studied the relationship between the pelvis and lumbar sagittal alignment, ethnic differences prevent their data from being used directly as a medical reference in Taiwan. This study introduced three major innovations: the first comprehensive stratification of pelvic incidence (PI) into three evenly distributed groups within Asian populations, the novel identification of critical partition zones in the lumbar spine, and the development of an ethnicity-specific correlation model between PI and lumbar lordosis. This study comprises two complementary parts. First, we conducted a prospective analysis of 324 asymptomatic Asian adults to examine the relationship between the lumbar sagittal alignment and PI. Second, we performed a systematic review incorporating four large-scale studies with over 100 participants each through a trend analysis of PI and lumbar lordosis to determine the optimal lumbar spine partition zones. Our analysis revealed distinct correlations between PI groups (G1, <45°; G2, 45-55°; G3, >55°) and segmental lordosis patterns. The proximal lordosis values were 11.6° ± 6.7°, 16° ± 7.7°, and 20.7° ± 8° for G1, G2, and G3, respectively, whereas the distal lordosis values were 30.7° ± 8.1°, 34.9° ± 7.9°, and 37° ± 9.3°, respectively. Furthermore, we identified a critical biomechanical transition zone between L3-L4 and L4-L5, demonstrating unique Asian-specific patterns of lumbar lordosis distribution. These findings provide essential reference values for preoperative planning of spinal surgery, assessment of pathological conditions, and development of population-specific treatment strategies. Our results contribute significantly to the understanding of Asian-specific spinal alignment patterns and offer valuable guidance for clinical practice.