儿童SDSG 5/6型发育不良性腰椎滑脱患者手术治疗后骨盆平衡情况变化

The pelvic balance after surgical treatment for pediatric SDSG 5/6 developmental spondylolisthesis

中文关键词:  腰椎滑脱  发育不良  骨盆参数  不平衡骨盆  儿童

英文关键词:Lumbar spondylolisthesis  Dysplasia  Pelvic parameters  Unbalanced pelvis  Children

中文摘要:

  【摘要】 目的：探讨在儿童重度发育不良性腰椎滑脱伴不平衡型骨盆[即脊柱畸形研究学组（Spinal Deformity Study Group，SDSG）分型5和6型]患者中手术复位及重建腰骶前凸对骨盆平衡的影响。方法：回顾性分析2015年2月～2019年2月手术治疗的23例儿童重度发育不良性腰椎滑脱患者，男2例，女21例，年龄9.6±2.4岁。均为L5滑脱，术前均伴有骨盆后倾。SDSG分型5型21例，6型2例。均行减压复位腰骶后凸矫正内固定融合术。测量术前及术后1年随访时脊柱骨盆矢状面相关参数，包括骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、L5倾斜角（L5 slope，L5S）、腰椎前凸角（lumbar lordosis，LL）、滑脱程度（slip percentage，SP）、SDSG发育不良腰骶角（SDSG dysplastic lumbosacral angle，SDSG-dys LSA）、Boxall′s滑脱角（Boxall′s slip angle，BSA）、Dubousset′s腰骶角（Dub-LSA）、腰骶后凸角（kyphotic Cobb angle，k-Cobb）。根据术后1年时骨盆旋转情况分为术后平衡型骨盆组和不平衡型骨盆组，对比两组患者后凸改善、滑脱复位率及近端固定椎的差异。结果：随访26±11个月（13～48个月），术后1年时PI无显著性改变（P>0.05），SS及Dub-LSA较术前均有显著性增加（P<0．05）；PT、L5S、LL、SP、SDSG dys-LSA及BSA较术前均有显著性减少（P<0．05）；k-Cobb由术前11.6°±12.8°改善至-11.5°±16.3°（P<0．05）；滑脱复位率为（85.5±16.4）%。术后1年时23例患者中有5例（22%）骨盆改善为平衡型，骨盆平衡组患者滑脱复位率显著性高于不平衡组（90.9% vs. 76.2%，P<0.05），两组腰骶后凸改善及近端固定椎位置无显著性差异（P>0.05）。结论：手术治疗儿童SDSG 5/6型发育不良性腰骶滑脱可有效改善脊柱-骨盆矢状位序列，部分患者可从不平衡型骨盆改善为平衡型骨盆，且骨盆平衡的改善与滑脱复位相关。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of surgical reduction and reconstruction of lumbosacral lordosis on the improvement of pelvic balance in children with high-grade developmental spondylolisthesis of type 5 and 6 according to Spinal Deformity Study Group(SDSG) classification. Methods: 23 children with high-grade developmental spondylolisthesis treated by operation from February 2015 to February 2019 were analyzed retrospectively. There were 2 males and 21 females, aged 5.3 to 13.8 years(9.6±2.4 years). All patients with retroverted pelvis before operation were classified into type 5 and 6 according to SDSG classification. All patients underwent decompression, reduction, lumbosacral kyphosis correction and internal fixation. The related parameters of sagittal plane of spine and pelvis were measured before operation and at one year follow-up, including pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), L5 slope(L5S), lumbar lordosis(LL), slip percentage(SP), SDSG dysplastic lumbosacral angle(SDSG-dysLSA), Boxall′s slip angle(BSA), Dubousset′s lumbosacral angle(Dub-LSA), and kyphotic Cobb angle(k-Cobb). All patients were divided into two groups according to postoperative pelvic rotation, group balanced pelvis and group unbalanced pelvis. Comparison of lumbosacral kyphosis, slippage reduction rate and proximal anchoring level was made between two groups. Results: The patients were followed up for 26±11 months(13-48 months). There was no significant change in PI(P>0.05). SS and Dub-LSA increased significantly(P<0.05). PT, L5S, LL, SP, SDSG dys-LSA and BSA decreased significantly(P<0.05). The k-Cobb was improved from 11.6°±12.8° to -11.5°±16.3°. The reduction rate of spondylolisthesis was (85.5±16.4)%. Of the 23 patients, 5(22%) had pelvic improvement to balanced type. Group of balanced pelvis had a higher reduction rate than group of unbalanced pelvis(90.9% vs. 76.2%, P<0.05). There was no significant difference on lumbosacral kyphosis and proximal anchoring level between two groups. Conclusions: Surgical reduction of spondylolisthesis and reconstruction of lumbosacral lordosis can improve the sagittal balance of spine-pelvis in children with dysplastic severe spondylolisthesis. 22% of the patients could be improved from unbalanced pelvis to balanced pelvis.