退变性腰椎侧凸矫形术后腰椎前凸角变化对临床疗效的影响

The postoperative effect of lumbar lordosis correction on patients with degenerative lumbar scoliosis

中文关键词:  退变性脊柱侧凸  矢状位平衡  理想腰椎前凸角  手术疗效

英文关键词:Degenerative lumbar scoliosis  Sagittal balance  Ideal lumbar lordosis  Postoperative effect

中文摘要:

  【摘要】 目的：评估退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）患者行长节段固定矫形术后腰椎前凸角与脊柱-骨盆矢状位参数匹配与否对临床疗效的影响。方法：对我院2015年6月～2016年6月行腰椎长节段矫形固定术（至少4个椎体）的DLS患者，参照理想腰椎前凸角（lumbar lordosis，LL）=0.6PI+0.4TK+10°，根据出院时LL分为两组，A组（匹配组，术后LL在理想LL±10°范围内）和B组（非匹配组，术后LL在理想LL±10°范围外），利用院内影像归档与通信系统（picture archiving and communication system，PACS）在全脊柱正侧位X线片上测量侧凸Cobb角、冠状位平衡（coronal vertical axis，CVA）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumber lordosis，LL）、胸椎后凸角（thoracic kyphosis，TK）、矢状位平衡（sagittal vertical axis，SVA）等，采用视觉模拟评分（visual analogue scale，VAS）、Oswestry功能障碍指数（Oswestry disability index，ODI）评价患者术后生活质量，随访至少12个月。使用独立样本t检验比较两组影像参数和生活质量评分。结果：共纳入患者100例（A组53例，B组47例），其中男性43例，女性57例，平均侧凸Cobb角为17.5°±7.8°。两组患者随访时间、手术节段、术前侧凸Cobb角、术前的CVA、LL、SS、SVA均无明显差异性（P＞0.05）；术后两组患者的LL、SS、SVA、PT具有明显差异性（P＜0.01），A组患者LL（42.2°±10.2°）较术前（31.6°±15.5°）明显改善，TK、SS增大，PT减小，术后SVA（17.9±28.5mm）较术前（46.0±37.9mm）明显改善。B组患者术后相关矢状位参数较术前均无明显变化。两组患者术后VAS评分、ODI评分较术前均有明显改善，经3~6个月的短期随访两组患者术后症状评分无明显差异性；经12个月以上随访，A组患者较B组患者腰腿痛VAS评分明显改善（P＜0.05），ODI评分无明显差异（P=0.08）。结论：退变性腰椎侧凸患者根据公式0.6PI+0.4TK+10°重建腰椎前凸，可以获得满意的脊柱-骨盆矢状位平衡，有助于提高DLS患者术后生活质量。

英文摘要:

  【Abstract】 Objectives: Prospective evaluation of the lumbar lordosis correction in patients with degenerative lumbar scoliosis(DLS) undergoing long-segmental operation. Methods: In our hospital, patients with DLS who underwent long-segment fixation(at least 4 vertebrae) were recruited. The ideal matched relation of the normal-elder people was LL=0.6PI+0.4TK+10°. The patients were divided into group A(matched group, postoperative LL in ideal LL±10°) and group B(mismatched group, postoperative LL out of ideal LL±10°). The pelvic and spinal parameters(Cobb angle, coronal vertical axis, pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, sagittal vertical axis) were measured on the anteroposterior and lateral radiographs. Pre- and post-operative symptoms were assessed by using the visual analog scale(VAS) for low back pain and leg pain. Oswestry disability index(ODI) was used to quantify disability. All patients achieved at least one-year follow-up. Parameters and clinical outcomes were compared by using independent t-test． Results: A total of 100 patients(53 in group A and 47 in group B) were included, with 43 males and 57 females, the average Cobb angle was 17.5°±7.8°. There was no significant difference between two groups in follow-up time, surgical segment, preoperative Cobb angle, preoperative CVA, preoperative LL, SS, and SVA(P>0.05). The LL, SS, PT and SVA of the two groups were significantly different after operation(P<0.01). The LL of group A significantly improved from preoperative 31.6°±15.5° to postoperative 42.2°±10.2°. The TK, SS increased and PT decreased. The postoperative SVA improved from 46±37.9mm to 17.9±28.5mm. While the sagittal parameters of group B showed no difference between pre- and post-operation. The VAS score or ODI score of the two groups significantly improved compared to the preoperative scores. After 3-6 months short-term follow-up, there was no significant difference between the two groups in VAS score and ODI score, but the VAS score of group A significantly improved after 12 months compared with group B(P＜0.05). The average ODI score of patients in group A was lower than that in group B, though there was no significant difference(P=0.08) between the two groups. Conclusions: The ideal LL(matched relation between LL and PI, TK) derived from the asymptomatic Chinese elder populations can rebalance the spine and lead to excellent clinical outcomes in DLS patients.