退行性腰椎侧凸合并冠状位整体失平衡矫形方式的初步研究

A pilot study of surgery tactics in the treatment of lumbosacral deformity in degenerative lumbar scoliosis with coronal global imbalance

中文关键词:  退行性腰椎侧凸畸形  腰骶段畸形  冠状位平衡

英文关键词:Degenerative lumbar scoliosis  Lumbosacral deformity  Coronal balance

中文摘要:

  【摘要】 目的：探索伴腰骶段畸形的退行性侧凸畸形的手术策略，以实现其冠状位失平衡的术中良好矫正，进而达到术后即刻的整体冠状位平衡。方法：2018年５月～2018年９月，对收治的5例伴腰骶段畸形的退变性脊柱侧凸患者行矫形手术。以患者术中俯卧位足跟连线中点、臀沟、C7棘突三个标记点作为矫形参考，腰段及腰骶段顶椎凹凸双侧充分松解，首先矫正主弯，而后利用体位垫复位作用，配合内固定整体把持矫形力，进行腰骶段畸形的矫正，实现三标记点共线。测量患者矫形前后站立位脊柱全长X线片的冠、矢状位脊柱骨盆参数，并进行比较。结果：5例患者均顺利完成手术，未发生严重并发症。患者术前冠状位失平衡距离、腰段主弯Cobb角、腰骶段代偿弯Cobb角、矢状位整体失平衡距离、骨盆入射角、骨盆倾斜角、腰椎前凸角、胸腰段后凸角、胸段后凸角分别为：3.9±1.1cm、35.3°±13.1°、24.5°±7.3°、11.0±9.2cm、49.8°±20.7°、33.8°±12.8°、8.7°±16.6°、11.3°±19.5°、14.4°±6.8°；术后分别为：-0.1±1.0cm、11.5°±10.3°、3.3°±4.0°、3.7±6.4cm、49.8°±19.1°、22.6°±7.7°、32.3°±9.0°、2.2°±18.0°、23.5°±2.7°。患者术后冠状位及矢状位整体平衡良好，较术前明显改善（P＜0.05）。结论：术中俯卧位足跟连线中点、臀沟、C7棘突三标记点的共线可作为术中冠状位是否平衡简单而实用的参考；凹凸双侧充分松解，体位复位及配合内固定的整体复位可实现腰骶椎畸形的良好矫正，进而恢复冠状位即刻的整体平衡。

英文摘要:

  【Abstract】 Objectives: To investigate the surgery tactics in the treatment of the degenerative lumbar scoliosis (DLS) with lumbosacral deformity, aiming to restore optimal coronal balance. Methods: From May 2018 to September 2018, orthopedic surgery was performed on 5 patients with degenerative scoliosis with lumbosacral deformity. Marked the midpoint of the heels, the gluteal fold and the spinous process of C7 as three reference points when patients were in prone position intra-operatively, and made thorough release in both concave and convex sides in apical vertebral areas. After corrected the main curve, corrected lumbosacral deformity by moving the posture pad to the opposite side and cooperating with controlling the internal fixation, to obtain the three points three points collinear. Parameters of coronal and sagittal alignments was measured in full-length spinal X-ray pre-and post-operatively. Results: All 5 patients successfully completed the operation without serious complications. The pre-operative coronal balance distance(CBD), lumbar Cobb, lumbosacral Cobb, sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), lumbar lordosis(LL), thoracolumbar kyphosis(TLK), thoracic kyphosis(TK) were respectively 3.9±1.1cm, 35.3°±13.1°, 24.5°±7.3°, 11.0±9.2cm, 49.8°±20.7°, 33.8°±12.8°, 8.7°±16.6°, 11.3°±19.5° and 14.4°±6.8°; the post-operative values were respectively -0.1±1.0cm, 11.5°±10.3°, 3.3°±4.0°, 3.7±6.4cm, 49.8°±19.1°, 22.6°±7.7°, 32.3°±9.0°, 2.2°±18.0° and 23.5°±2.7°. Both coronal and sagittal balance was well after operation, which was obviously improved compared with that pre-operation(P＜0.05). Conclusions: The midpoint of the heels, the gluteal fold and the spinous process of C7 is good reference points to evaluate the global coronal balance in intra-operation. Thorough release in both concave and convex sides and postural reduction cooperating with internal fixation reduction is important to restore global coronal balance.