后路S1截骨复位融合术治疗青少年L5重度滑脱患者的远期疗效

Long-term outcome of posterior S1 osteotomy and reduction surgery on adolescent high-grade spondylolisthesis

中文关键词:  青少年重度腰椎滑脱  S1截骨复位融合术  远期疗效

英文关键词:Adolescent lumbar spondylolisthesis  High-grade  S1 osteotomy  Long-term outcome

中文摘要:

  【摘要】 目的：评估后路S1截骨复位融合术治疗青少年L5重度滑脱患者的远期疗效及影像学参数变化。方法：回顾性分析2008年1月~2015年1月于我院行后路S1截骨复位融合术治疗的青少年L5重度滑脱患者21例，其中男性13例，女性8例；年龄14.4±5.2岁（9~21岁），体质指数（body mass index，BMI）23.4±6.5kg/m2，随访时间73.7±11.3个月（60~96个月），术前滑脱Meyerding分度Ⅲ度13例，Ⅳ度5例，Ⅴ度3例。记录所有患者术前、术后6个月及终末随访时的滑移率、矢状面轴向垂直距离（sagittal vertical axis，SVA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、骨盆投射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、腰骶后凸角（lumbaosacral angle，LSA）及腰痛视觉模拟评分（lumbar visual analogue scale，lumbar-VAS）、腿痛视觉模拟评分（leg visual analogue scale，leg-VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分，并采用JOA评分评价临床治疗改善率，改善率≥50%者评定为优良。采用脊柱侧凸研究学会22项问卷表（scoliosis research society questionnaire-22，SRS-22），评估各组术前、术后6个月及终末随访时疼痛、自我形象、活动度、精神、治疗满意度评分。应用卡方检验、Fisher精确检验、独立样本t检验统计分析青少年重度腰椎滑脱经后路S1截骨复位融合术后的远期疗效。结果：末次随访JOA评分总优良率为80.95%，融合率95.23%，滑脱复位率（71.22±6.7）%，内固定断裂并假关节形成1例，予翻修手术。滑脱复位术后6个月较术前PT（24.7°±7.6° vs 34.3°±10.7°）、SS（48.2°±6.7° vs 38.4°±16.4°）、LL（-42.3°±9.4° vs -63.4°±12.4°）、LSA（-7.3°±5.4° vs 18.3°±6.4°）、TK（18.6°±12.7° vs 9.4°±22.6°）、SVA（1.4±2.7cm vs 3.1±2.7cm）均显著改善（P<0.05），PI（73.2°±10.8° vs 73.6°±11.3°）较术前无明显变化（P<0.05）。终末随访较术后6个月PI（81.6°±13.7° vs 73.2°±10.8°）、PT（28.3°±8.6° vs 24.7°±7.6°）、SS（52.2°±13.3° vs 48.2°±6.7°）、LL（-56.4°±15.3° vs -42.3°±9.4°）改变有统计学意义（P<0.05），LSA（-7.1°±5.8° vs -7.3°±5.4°）、TK（15.4°±12.4° vs 18.6°±12.7°）、SVA（1.2±3.1cm vs 1.4±2.7cm）较术后6个月无统计学意义（P＞0.05）。术后6个月腰痛VAS（1.8±1.4分 vs 6.8±2.1分）、腿痛VAS（1.5±1.1分 vs 5.4±1.3分）、JOA评分（22.5±5.7分 vs 8.5±3.4分）、ODI[（15.2±5.5）% vs （42.6±7.5）%]、SRS-22疼痛（4.2±0.8分 vs 2.8±0.8分）、自我形象（4.6±0.5分 vs 3.1±0.6分）、活动度（4.3±0.6分 vs 3.4±0.6分）、精神（4.2±0.6分 vs 3.3±0.7分）、总评分（4.3±0.5分 vs 3.2±0.4分）较术前均显著改善有统计学意义（P<0.05）。终末随访时，腰痛VAS（3.6±1.2分 vs 1.8±1.4分）、SRS-22疼痛评分（3.7±0.6分 vs 4.2±0.8分）较术后6个月增加并有统计学意义（P<0.05），余各项无明显变化（P>0.05）。结论：青少年L5重度滑脱患者行后路S1截骨复位融合术可有效改善临床症状及影像学矢状面序列。

英文摘要:

  【Abstract】 Objectives: To analyze the long-term outcome and radiographic parameter changes of posterior S1 osteotomy and reduction surgery on adolescent high-grade L5 spondylolisthesis. Methods: 21 cases of adolescent high-grade L5 spondylolisthesis who received posterior S1 osteotomy and reduction surgery between January 2008 and January 2015 in our medical center were retrospectively analyzed. There were a total of 13 males and 8 females with an average age of 14.4±5.2 years old and average BMI of 23.4±6.5kg/m2. The average follow up period was 73.7±11.3 months. The Meyerding classification status were as follows: 13 cases of grade Ⅲ, 5 cases of grade Ⅳ, and 3 cases of grade Ⅴ. General epidemiological data includinglumbar-VAS, leg-VAS, ODI, JOA score, SRS-22 score and radiologic parameters of slippage rate, SVA, TK, LL, PI, PT, SS, and LSA at preoperation, 6 months postoperatively and final follow-up were collected. Chi square test and independent sample T-test were used for statistical analysis of imaging parameters and SRS-22 questionnaire scores. Results: At final follow-up, the superior rate of JOA was 80.95%, the fusion rate was 95.23%. Amelioration of lumbar spondylolisthesis was 71.22%. One case developed screw breakage and received revision surgery. Comparing between parameters at 6 months follow-up and before surgery: PT(24.7°±7.6° vs 34.3°±10.7°), SS(48.2°±6.7° vs 38.4°±16.4°), LL(-42.3°±9.4° vs -63.4°±12.4°), LSA(-7.3°±5.4° vs 18.3°±6.4°), TK(18.6°±12.7° vs 9.4°±22.6°) and SVA(1.4±2.7cm vs 3.1±2.7cm) improved significantly(P<0.05); while PI(73.2°±10.8° vs 73.6°±11.3°, P>0.05) presented no significant change. Comparing between parameters at final follow-up and at 6 months follow-up: PI(81.6°±13.7° vs 73.2°±10.8°), PT(28.3°±8.6° vs 24.7°±7.6°), SS(52.2°±13.3° vs 48.2°±6.7°) and LL(-56.4°±15.3° vs -42.3°±9.4°) improved significantly(P<0.05): whiles LSA (-7.1°±5.8° vs -7.3°±5.4°), TK(15.4°±12.4° vs 18.6°±12.7°) and SVA(1.2±3.1cm vs 1.4±2.7cm) presented no significant change. Lumbar-VAS(1.8±1.4 vs 6.8±2.1), leg-VAS(1.5±1.1 vs 5.4±1.3), JOA(22.5±5.7 vs 8.5±3.4), ODI[(15.2±5.5)% vs (42.6±7.5)%], SRS-22 pain score(4.2±0.8 vs 2.8±0.8), self-image score(4.6±0.5 vs 3.1±0.6), activity score(4.3±0.6 vs 3.4±0.6), mental score(4.2±0.6 vs 3.3±0.7) and total score(4.3±0.5 vs 3.2±0.4) at the 6 months follow-up showed various dimensions changes compared with that preoperatively(P<0.05). Lumbar-VAS (3.6±1.2 vs 1.8±1.4) and SRS-22 pain score(3.7±0.6 vs 4.2±0.8) deteriorated at final follow-up(P<0.05). Conclusions: Posterior S1 osteotomy and reduction surgeryon adolescent high-grade spondylolisthesis could achieve satisfying clinical symptoms and sagittal alignment improvement at more than five years follow-up.