郭新虎,李危石,郭昭庆,陈仲强,齐 强,曾 岩,孙垂国,钟沃权.高度发育不良性腰椎滑脱复位程度与脊柱-骨盆矢状位参数变化的关系[J].中国脊柱脊髓杂志,2020,(8):679-686. |
高度发育不良性腰椎滑脱复位程度与脊柱-骨盆矢状位参数变化的关系 |
中文关键词: 高度发育不良性腰椎滑脱 复位 脊柱-骨盆参数 |
中文摘要: |
【摘要】 目的:分析高度发育不良性腰椎滑脱(high dysplastic developmental spondylolisthesis,HDDS)的手术复位程度与脊柱-骨盆矢状位参数变化的关系,以了解复位至何种程度能够显著改善术后脊柱-骨盆矢状位序列。方法:回顾性分析2007年3月~2019年4月在我院骨科接受手术治疗的35例HDDS患者,滑脱节段均为L5,年龄14.9±5.9岁(9~35岁)。均行减压、部分复位或完全复位、椎弓根螺钉内固定融合术。随访42.5±33.1个月(3~120个月)。依据术后末次随访时的Dubousset腰骶角(Dubousset lumbosacral angle,Dub-LSA)将患者分为<70°(7例)、70°~79.9°(8例)、80°~89.9°(4例)及≥90°(16例)四组,依据末次随访时滑脱的Meyerding分度将患者分为Ⅲ度及以上(5例)、Ⅱ度(6例)、Ⅰ度以内(24例)三组,分别对比各组的术前、末次随访时脊柱-骨盆参数的变化。结果:滑脱率术前为(66.7±22.5)%(35%~100%),末次随访时为(18.9±20.9)%(0%~72%);Dub-LSA术前为61.9°±14.7°,末次随访时82.1°±17.3°。末次随访时Dub-LSA越大、滑脱程度越低,脊柱-骨盆矢状位参数较术前改善越明显;直至Dub-LSA≥90°和滑移程度在Ⅰ度以内时,骨盆倾斜角(pelvic tilt,PT)和骶骨倾斜角(sacral slope,SS)均有显著性改善,由后倾型骨盆转变为平衡型骨盆的比例显著增加。Dub-LSA≥90°组术前与末次随访时PT分别为36.4°±6.5°与27.2°±4.9°(P<0.001)、SS分别为33.5°±9.1°与42.1°±9.3°(P<0.001)、平衡型骨盆比例分别为0%(0/16)与43.8%(7/16)(P=0.007), 末次随访时与术前比较均有统计学差异。末次随访时滑脱程度在Ⅰ度以内组,术前与末次随访时PT分别为38.9°±8.6°与30.6°±7.4°(P<0.001)、SS分别为31.4°±11.5°与41.2°±8.7°(P<0.001)、平衡型骨盆比例分别为0%(0/24)与29.2%(7/24)(P=0.009),末次随访时与术前比较均有统计学差异。结论:将HDDS患者的Dub-LSA复位至≥90°和将滑移复位至Ⅰ度以内能够显著改善脊柱-骨盆矢状位参数,并且能够将部分(43.8%)后倾型骨盆改善为平衡型骨盆。 |
The relationship between the extent of reduction and the change of spino-pelvic parameters in high dysplastic developmental spondylolisthesis |
英文关键词:High dysplastic developmental spondylolisthesis Reduction Spino-pelvic alignment |
英文摘要: |
【Abstract】 Objectives: To investigate the relationship between the extent of reduction and the change of spino-pelvic parameters in high dysplastic developmental spondylolisthesis(HDDS), so as to know about what extent of reduction could significantly improve postoperative spino-pelvic sagittal alignment. Methods: Thirty-five young patients of HDDS, aged 9 to 35 (14.9±5.9) years old and treated between March 2007 and April 2019 in our hospital were studied retrospectively, with an average follow-up time of (42.5±33.1) months (3-120 months). They were divided into four groups of <70°(7 cases), 70°-79.9°(8 cases), 80°-89.9°(4 cases) and ≥90° (16 cases) based on the final follow-up Dubousset lumbosacral angle(Dub-LSA), and were also divided into three groups of high-grade (grade Ⅲ and above) (5 cases), grade Ⅱ(6 cases), and grade Ⅰ(24 cases) based on the final follow-up Meyerding grade. Then, the preoperative and final follow-up spino-pelvic parameters of each group were compared to find out what extent of reduction could significantly improve these parameters and pelvic balance. Results: The slip percentage was [pre-operation (66.7±22.5)% (range 35%-100%) vs. final follow-up (18.9±20.9)% (range 0%-72%)]. The Dub-LSA was (pre-operation 61.9°±14.7° vs. final follow-up 82.1°±17.3°). The differences between preoperative and final follow-up parameters became more significant with the increase of Dub-LSA and the decrease of slippage. In the Dub-LSA ≥90° and the grade Ⅰ group, pelvic tilt(PT) and sacral slope(SS) were improved significantly, and the ratio of retroverted pelvis changing into balanced type was increased significantly. Dub-LSA ≥90° group: PT [pre-operation (36.4°±6.5°) vs. final follow-up (27.2°±4.9°), P<0.001], SS [pre-operation (33.5°±9.1°) vs. final follow-up (42.1°±9.3°), P<0.001], and the ratio of balanced pelvis [pre-operation 0%(0/16) vs. final follow-up 43.8% (7/16), P=0.007]. Grade Ⅰ group: PT [pre-operation (38.9°±8.6°) vs. final follow-up (30.6°±7.4°), P<0.001], SS [pre-operation (31.4°±11.5°) vs. final follow-up (41.2°±8.7°), P<0.001], and the ratio of balanced pelvis [pre-operation 0%(0/24) vs. final follow-up 29.2%(7/24), P=0.009]. Conclusions: Reduction of HDDS to Dub-LSA ≥90° and Meyerding grade Ⅰ could improve the spino-pelvic alignment significantly, and could convert part (43.8%) of the retroverted pelvis to balanced pelvis. |
投稿时间:2020-06-05 修订日期:2020-07-08 |
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