骨盆腰椎匹配值与成人退变性脊柱侧凸畸形术后疗效的相关性研究

The correlation study between PI-LL value and its clinical outcome in adult degenerative scoliosis deformity correction

中文关键词:  脊柱骨盆参数  骨盆腰椎匹配值  矢状位平衡

英文关键词:Spino-pelvic alignment  PI-LL  Sagittal balance

中文摘要:

  【摘要】 目的：探讨成人退变性脊柱侧凸畸形患者骨盆腰椎匹配值（PI-LL）与术后临床疗效的关系。方法：选取2011年1月～2012年12月间因退变性脊柱侧凸于我院行长节段减压融合手术的患者共42例，随访时间3年以上。术前及末次随访时行站立位脊柱全长正侧位X线片检查，记录患者视觉模拟评分（visual analogue scale，VAS）和Oswestry 功能障碍评分（Oswestry disability index，ODI）。影像学上测量侧凸Cobb角、骨盆投射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）、腰椎前凸（lumbar lordosis，LL）、胸椎后凸（thoracic kyphosis，TK）、骨盆腰椎前凸角（pelvic radius-T12，PR-T12）、T1骨盆角（T1 pelvic angle，TPA）和矢状垂直轴（sagittal vertical axis，SVA）。统计患者术前术后影像学参数和功能评分的改善情况，分析这些参数与PI-LL值的相关性及不同PI-LL值对患者生活质量（ODI）的影响。结果：患者平均年龄68.8岁。术前冠状位侧凸Cobb角为19.5°±5.4°，末次随访时改善为6.1°±3.5°，差异显著（P<0.01）。腰椎前凸由术前平均20.7°增加至34.3°，末次随访时平均PI-LL为9.0°，SVA由术前平均7.6cm减少至5.7cm，差异显著（P<0.01）。术前矢状位平衡组患者10例，末次随访时PI-LL为1.0°±5.9°。矢状位失衡组患者32例，末次随访时PI-LL为11.8°±9.0°。两组术前的VAS和ODI评分无显著差异，术后均得到明显改善；两组术后VAS和ODI评分差异无统计学意义（P=0.074/0.053）。术后PI-LL与术后PR-T12、TPA、SVA、VAS及ODI显著相关。末次随访时PI-LL≤10°与10°15°组间差异显著（P=0.010/0.048）。结论：成人退变性脊柱侧凸畸形患者手术治疗时应注意对矢状位的充分评估。对于高龄患者，术后PI-LL≤15°提示骨盆腰椎匹配良好，有助于维持脊柱-骨盆矢状位平衡，显著提高患者的临床疗效和生活质量。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between the PI-LL value and its clinical outcomes after adult degenerative scoliosis surgery. Methods: 42 patients who received long-segment correction for degenerative scoliosis between January 2011 and December 2012 in our hospital were analyzed retrospectively. Follow-ups were more than 3 years. Pre-operatively and at final follow-up, patients undertook full-long standing X-ray of spine, meanwhile VAS and ODI scores were recorded. The scoliosis Cobb′s angle, pelvic incidence, sacral slope, pelvic tilt, lumbarlordosis, thoracic kyphosis, pelvic radius-T12, T1 pelvic angle and sagittal vertical axis were measured. The radiological parameters and clinical function scores pre- and post-operatively were compared, to analysis the correlation of these parameters with PI-LL value, and the impact on patients quality of life(ODI) of different PI-LL values. Results: The average age of patients was 68.8 years. Pre-operative scoliosis Cobb′s angle was 19.5°±5.4°, which improved to 6.1°±3.5° at final follow-up(P<0.01). The average lumbar lordosis increased from 20.7° to 34.3°, PI-LL was 9.0° at final follow-up and SVA decreased from 7.6cm to 5.7cm, the differences were significant(P<0.01). Sagittal balanced group included 10 patients, PI-LL was 1.0°±5.9° at final follow-up. Sagittal unbalanced group included 32 patients， PI-LL was 11.8°±9.0° at final follow-up. Pre-operative VAS and ODI scores between two groups were not significant, but improved obviously at final follow-up. There were no significant differences with VAS and ODI scores between two groups at final follow-up(P=0.074/0.053). Post-operative PI-LL had significant correlations with postoperative PR-T12, TPA, SVA, VAS and ODI score. ODI score between PI-LL≤10°group and 10°15° group(P=0.010/0.048). Conclusions: The sagittal alignment during surgical treatment for degenerative scoliosis should be carefully evaluated. Post-operative PI-LL<15° suggests matched pelvis and lumbar lordosis for senior patients, helps to maintain the spino-pelvic balance, and significantly improves the patients′ clinical outcome and quality of life.