儿童发育不良性重度腰椎滑脱手术复位后脊柱-骨盆矢状位序列改变

Sagittal spino-pelvic alignment after surgical reduction for pediatric high-grade developmental spondylolisthesis

中文关键词:  腰椎滑脱  复位  矢状位序列  手术  儿童

英文关键词:Spondylolisthesis  Reduction  Sagittal alignment  Surgery  Child

中文摘要:

  【摘要】 目的：评估手术复位对儿童L5发育不良性重度滑脱患者脊柱-骨盆矢状位序列的影响。方法：回顾性分析13例行手术复位治疗的儿童L5发育不良性重度滑脱患者，其中男2例，女11例。均行减压复位内固定融合术。手术时年龄11.5±2.4岁（7~15岁）。采用配对样本t检验比较术前、末次随访时的滑脱程度（slip de?鄄gree）、腰椎前凸角（lumbar lordosis，LL）、Boxall滑脱角（Boxall′s slip angle，BSA）、SDSG发育不良性腰骶角（Spinal Deformity Study Group dysplastic lumbosacral angle, SDSG-dys LSA）、骨盆投射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）的差异，评估手术复位后脊柱-骨盆矢状位序列的变化。结果：随访20.6±21.9个月（3~64个月），滑脱程度由术前的（76.01±15.65）%改善至末次随访时的（17.57±16.64）%（P<0.01），滑脱复位程度为（58.44±16.31）%，其中4例Ⅲ度滑脱患者完全复位。11例患者行S1上终板拱顶样部分切除，平均切除程度为（30.16±14.54）%。术前、末次随访时的LL分别为74.75°±18.11°、57.77°±14.83°，BSA分别为48.98°±16.01°、19.56°±18.70°，SDSG-dys LSA分别为19.78°±20.19°、-1.72°±19.04°，SS分别为28.68°±23.21°、41.13°±15.67°，末次随访时均较术前有显著性改变（P<0.05）；PI分别为65.64°±19.88°、73.20°±18.85°，PT分别为36.88°±11.68°、32.03°±11.76°，末次随访时较术前无显著性改变（P>0.05）。C7铅垂线距骶骨后上角距离（sagittal vertical axis，SVA）较术前减小。末次随访时10例后倾型骨盆患者中2例（20%）转变为平衡型骨盆。结论：手术复位可改善儿童L5发育不良性重度滑脱患者脊柱-骨盆矢状位序列，矫正腰骶部后凸畸形，改善骶骨-骨盆矢状位序列。

英文摘要:

  【Abstract】 Objectives: To determine the effect of surgical reduction for pediatric L5 high-grade developmental spondylolisthesis on the sagittal spino-pelvic alignment. Methods: Thirteen children(two boys and eleven girls) with L5 high-grade developmental spondylolisthesis were retrospectively evaluated in this study, all cases underwent the process of decompression, reduction, internal fixation and fusion. Radiological assessment of spino-pelvic sagittal alignment was carried out. The average age at surgery was 11.5±2.4 years(range 7-15 years). The differences of radiological parameters[slip degree, lumbar lordosis(LL), Boxall′s slip angle(BSA), Spinal Deformity Study Group dysplastic lumbosacral angle(SDSG-dys LSA), pelvic incidence(PI), pelvic tilt(PT) and sacral slope(SS)] between preoperation and final follow-up were compared by the paired sample t test. Results: The average follow-up time was 20.6±21.9 months(range, 3-64 months). Spondylolisthesis decreased from the average (76.01±16.64)% at preoperation to (17.57±16.64)% at final follow-up(P<0.01), with the improvement rate of (58.44±16.31)%, four children with grade Ⅲ spondylolisthesis got completely reduction. Sacral dome osteotomy was performed in 11 patients, with the correction rate of (30.16±14.54)%. All patients showed statistically significant changes of above parameters at final follow-up compared with preoperative ones(P<0.05). LL decreased from 74.75°±18.11° to 57.77°±14.83°, BSA from 48.98°±16.01° to 19.56°±18.70°, SDSG-dys LSA from 19.78°±20.19° to -1.72°±19.04°, while SS increased from 28.68°±23.21° to 41.13°±15.67°. PI increased from 65.64°±19.88° to 73.20°±18.85° and PT decreased from 36.88°±11.68° to 32.03°±11.76°, which showed no statistically significant changes at final follow-up compared with preoperative ones(P>0.05). Sagittal vertical axis(SVA) decreased compared with preoperative ones. Improvements of pelvic sagittal alignment after surgical reduction in the retroverted pelvis group were more obvious than those in the balanced pelvis group, 20% of the cases shifted from retroverted pelvis to balanced pelvis at final follow-up. Conclusions: Surgical reduction for pediatric L5 high-grade developmental spondylolisthesis can improve the spino-pelvic and sacro-pelvic sagittal alignment, and correct the lumbosacral kyphosis.