成人脊柱侧凸患者长节段脊柱融合术后髋关节疼痛与脊柱-骨盆-髋关节参数的相关性分析

Correlation analysis between postoperative hip pain and spino-pelvic-hip parameters in adult scoliosis patients after long-segment spinal fusion

中文关键词:  脊柱侧凸  髋关节  脊柱-骨盆参数  髋臼覆盖率  成人

英文关键词:Scoliosis  Hip joint  Spine-pelvic parameters  Acetabular coverage  Adult

中文摘要:

  【摘要】 目的：探讨成人脊柱侧凸患者长节段脊柱融合术后髋关节疼痛与脊柱-骨盆-髋关节参数的相关性。方法：回顾2009年12月~2015年8月于北京大学第三医院行长节段脊柱融合固定手术（融合节段数≥4，下端固定至骶髂骨）、术前无髋部疼痛或髋臼发育不良、临床资料完整、随访2年以上的成人脊柱侧凸患者76例，根据末次随访是否有髋部疼痛分为疼痛组及对照组，其中疼痛组34例，对照组42例。两组间年龄、性别、融合节段数、身体质量指数（body mass index，BMI）及是否行第二骶椎骶髂（sacral-2 alar iliac，S2AI）螺钉固定均无统计学差异（P＞0.05）。记录疼痛组末次随访髋部疼痛VAS评分；在骨盆正位X线片上分别测量和记录两组患者术前及末次随访时的髋臼覆盖率、tonnis角、中心边缘角（CE角），在全脊柱正侧位X线片上测量和记录手术前及末次随访时的腰椎前凸角（lumber lordosis，LL）、骶骨倾斜角（sacrum slop，SS）及骨盆入射角（pelvic incidence，PI）、Cobb角、冠状位平衡（coronal vertical axis，CVA）、矢状位平衡（sagittal vertical axis，SVA），运用t检验、方差分析及Person相关性检验等方法进行两组间参数变化的比较及疼痛组髋臼覆盖率、tonnis角、CE角变化量与LL、SS、PI变化量的相关性分析。结果：疼痛组末次随访时髋部疼痛VAS评分3.9±1.4分（2~7分）；两组间术前与末次随访时髋臼覆盖率的变化、CE角的变化有统计学差异（P＜0.05），tonnis角、LL、SS、PI、CVA、SVA、Cobb角的变化无显著性差异（P＞0.05）。疼痛组术前与末次随访时髋臼覆盖率的变化与LL的变化有显著相关性（P＜0.05），与SS、PI变化量无显著相关性，CE角、tonnis角与LL、SS、PI的变化无显著相关性（P＞0.05）。结论：成人脊柱侧凸患者长节段脊柱融合术后髋部疼痛与髋臼覆盖率及CE角变化相关，且髋臼覆盖率变化与LL变化相关。

英文摘要:

  【Abstract】 Objectives: To explore the correlations between postoperative hip pain and spino-pelvic-hip parameters in adult scoliosis patients after long-segment spinal fusion. Methods: This study was a retrospective analysis of a cohort of 76 adult scoliosis patients who underwent long-segment spinal fusions at Peking University Third Hospital between December 2009 and August 2015. The inclusion criteria included: (1) at least four segments involved, with the lower end of fixation at sacrum or ilium; (2) no preoperative hip pain or acetabular dysplasia; (3) complete clinical data; and (4) at least two years of follow-up. The patients were divided into pain group(PG) and control group(CG) based on whether hip pain was reported at the end of follow-up. There were 34 cases in PG and 42 in CG. There were no significant differences in age, gender, number of fusion segments, body mass index(BMI) and the use of sacral-2 alar iliac(S2AI) screw between the two groups(P＞0.05）. Visual analog scale(VAS) was usd to assess the postoperative hip pain in PG patients. Two sets of parameters were measured and recorded for all patients before and after the fusion surgery. The first set was based on anterior pelvic radiograph and consisted of acetabular coverage, tonnis angle, central-edge angle（CE angle）; the second set was measured on both anterior and lateral full-spine radiographs, including lumber lordosis(LL), sacrum slop(SS), pelvic incidence(PI), Cobb angle, coronal vertical axis(CVA) and sagittal vertical axis(SVA). t-test, variance analysis, and Pearson correlation analysis were used to compare the parameters between groups and analysis correlations of acetabular coverage, tonnis angle, CE angle variables and LL, SS and PI variables in PG. Results: The average VAS score of PG patients was 3.9±1.4(range: 2-7). There were statistically significant differences in the alterations of acetabular coverage and CE angle between the two groups(P<0.05), but none in those of tonnis angle, LL, SS, PI, CVA, SVA and Cobb angle. The alteration of acetabular coverage before and after operation in PG was significantly correlated with that of LL(P<0.05), while CE angle and tonnis angle were not significantly correlated with spinal-pelvic parameters(P>0.05). Conclusions: There is significant correlation between hip pain and acetabular coverage, CE angle after long-segment spinal fusion of adult scoliosis patients, and acetabulum coverage changes are correlated with changes in LL in the PG.