高度发育不良性腰椎滑脱复位程度与脊柱-骨盆矢状位参数变化的关系

The relationship between the extent of reduction and the change of spino-pelvic parameters in high dysplastic developmental spondylolisthesis

中文关键词:  高度发育不良性腰椎滑脱  复位  脊柱-骨盆参数

英文关键词:High dysplastic developmental spondylolisthesis  Reduction  Spino-pelvic alignment

中文摘要:

  【摘要】 目的：分析高度发育不良性腰椎滑脱（high dysplastic developmental spondylolisthesis，HDDS）的手术复位程度与脊柱-骨盆矢状位参数变化的关系，以了解复位至何种程度能够显著改善术后脊柱-骨盆矢状位序列。方法：回顾性分析2007年3月~2019年4月在我院骨科接受手术治疗的35例HDDS患者，滑脱节段均为L5，年龄14.9±5.9岁（9~35岁）。均行减压、部分复位或完全复位、椎弓根螺钉内固定融合术。随访42.5±33.1个月（3~120个月）。依据术后末次随访时的Dubousset腰骶角（Dubousset lumbosacral angle，Dub-LSA）将患者分为<70°（7例）、70°~79.9°（8例）、80°~89.9°（4例）及≥90°（16例）四组，依据末次随访时滑脱的Meyerding分度将患者分为Ⅲ度及以上（5例）、Ⅱ度（6例）、Ⅰ度以内（24例）三组，分别对比各组的术前、末次随访时脊柱-骨盆参数的变化。结果：滑脱率术前为（66.7±22.5）%（35%~100%），末次随访时为（18.9±20.9）%（0%~72%）；Dub-LSA术前为61.9°±14.7°，末次随访时82.1°±17.3°。末次随访时Dub-LSA越大、滑脱程度越低，脊柱-骨盆矢状位参数较术前改善越明显；直至Dub-LSA≥90°和滑移程度在Ⅰ度以内时，骨盆倾斜角（pelvic tilt，PT）和骶骨倾斜角（sacral slope，SS）均有显著性改善，由后倾型骨盆转变为平衡型骨盆的比例显著增加。Dub-LSA≥90°组术前与末次随访时PT分别为36.4°±6.5°与27.2°±4.9°（P<0.001）、SS分别为33.5°±9.1°与42.1°±9.3°（P<0.001）、平衡型骨盆比例分别为0%（0/16）与43.8%（7/16）（P=0.007）， 末次随访时与术前比较均有统计学差异。末次随访时滑脱程度在Ⅰ度以内组，术前与末次随访时PT分别为38.9°±8.6°与30.6°±7.4°（P<0.001）、SS分别为31.4°±11.5°与41.2°±8.7°（P<0.001）、平衡型骨盆比例分别为0%（0/24）与29.2%（7/24）（P=0.009），末次随访时与术前比较均有统计学差异。结论：将HDDS患者的Dub-LSA复位至≥90°和将滑移复位至Ⅰ度以内能够显著改善脊柱-骨盆矢状位参数，并且能够将部分（43.8%）后倾型骨盆改善为平衡型骨盆。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between the extent of reduction and the change of spino-pelvic parameters in high dysplastic developmental spondylolisthesis(HDDS), so as to know about what extent of reduction could significantly improve postoperative spino-pelvic sagittal alignment. Methods: Thirty-five young patients of HDDS, aged 9 to 35 (14.9±5.9) years old and treated between March 2007 and April 2019 in our hospital were studied retrospectively, with an average follow-up time of (42.5±33.1) months (3-120 months). They were divided into four groups of <70°(7 cases), 70°-79.9°(8 cases), 80°-89.9°(4 cases) and ≥90° (16 cases) based on the final follow-up Dubousset lumbosacral angle(Dub-LSA), and were also divided into three groups of high-grade (grade Ⅲ and above) (5 cases), grade Ⅱ(6 cases), and grade Ⅰ(24 cases) based on the final follow-up Meyerding grade. Then, the preoperative and final follow-up spino-pelvic parameters of each group were compared to find out what extent of reduction could significantly improve these parameters and pelvic balance. Results: The slip percentage was [pre-operation (66.7±22.5)% (range 35%-100%) vs. final follow-up (18.9±20.9)% (range 0%-72%)]. The Dub-LSA was (pre-operation 61.9°±14.7° vs. final follow-up 82.1°±17.3°). The differences between preoperative and final follow-up parameters became more significant with the increase of Dub-LSA and the decrease of slippage. In the Dub-LSA ≥90° and the grade Ⅰ group, pelvic tilt(PT) and sacral slope(SS) were improved significantly, and the ratio of retroverted pelvis changing into balanced type was increased significantly. Dub-LSA ≥90° group: PT [pre-operation (36.4°±6.5°) vs. final follow-up (27.2°±4.9°), P<0.001], SS [pre-operation (33.5°±9.1°) vs. final follow-up (42.1°±9.3°), P<0.001], and the ratio of balanced pelvis [pre-operation 0%(0/16) vs. final follow-up 43.8% (7/16), P=0.007]. Grade Ⅰ group: PT [pre-operation (38.9°±8.6°) vs. final follow-up (30.6°±7.4°), P<0.001], SS [pre-operation (31.4°±11.5°) vs. final follow-up (41.2°±8.7°), P<0.001], and the ratio of balanced pelvis [pre-operation 0%(0/24) vs. final follow-up 29.2%(7/24), P=0.009]. Conclusions: Reduction of HDDS to Dub-LSA ≥90° and Meyerding grade Ⅰ could improve the spino-pelvic alignment significantly, and could convert part (43.8%) of the retroverted pelvis to balanced pelvis.