退变性腰椎侧凸伴骨盆倾斜的影像学特征及矫形术后转归

Imaging features and postoperative outcomes in patients with degenerative lumbar scoliosis and pelvic obliquity

中文关键词:  退变性腰椎侧凸  骨盆倾斜  影像学参数  矫形手术  矫形策略

英文关键词:Degenerative lumbar scoliosis  Pelvic obliquity  Imaging features  Orthopedics surgery  Orthopedics strategy

中文摘要:

  【摘要】 目的：总结退变性腰椎侧凸患者伴骨盆倾斜的影像学特征，并分析脊柱矫形术后相关的影像学参数和骨盆倾斜的转归。方法：回顾性分析2005年1月~2019年12月在我院行后路脊柱侧凸矫形内固定融合手术的181例退变性腰椎侧凸患者的临床资料。术前合并骨盆倾斜20例，年龄46~75岁（62.10±7.56岁），随访时间12~96个月（47.21±19.13个月）。15例患者C7铅垂线（C7PL）偏移方向与骨盆髂嵴较高侧保持一致，定义为Ⅰ型；5例患者C7PL偏移方向与骨盆髂嵴较低侧一致，定义为Ⅱ型。收集患者术前、术后即刻及末次随访时的Cobb角、冠状位平衡（coronal vertical axis，CVA）、锁骨角（clavicle angle，CA）、顶椎偏距（apical vertebral translation，AVT）、骶骨倾斜角（sacral obliquity angle，SOA）、骨盆倾斜角（pelvic obliquity angle，POA）等影像学参数以及顶椎位置、融合节段、截骨方式、远端固定椎位置等临床指标，并进行组内比较与组间比较。结果：Ⅰ型组术后及末次随访时的Cobb角、AVT、POA均显著小于术前（P＜0.05），CVA、CA和SOA与术前比较均无统计学差异（P＞0.05）。Ⅱ型组术后Cobb角、AVT、POA显著小于术前（P＜0.05），CVA、CA、SOA与术前比较均无明显差异（P＞0.05）；末次随访SOA、AVT显著小于术前（P＜0.05），Cobb角、CVA、CA、POA与术前比较无统计学差异（P＞0.05）。Ⅱ型组术前SOA与AVT、术后Cobb角及末次随访时AVT与SOA均显著大于Ⅰ型组（P＜0.05），其他影像学参数两组间比较无显著性差异（P＞0.05）。Ⅰ型组与Ⅱ型组远端固定椎、顶椎位置、融合节段数、截骨方式等临床指标无明显差异（P＞0.05）。术后骨盆持续倾斜5例，骨盆倾斜改善15例，改善率75%。术后骨盆持续倾斜患者术后及末次随访时上述影像学参数较术前无显著性差异（P＞0.05）；术后骨盆倾斜改善组术后及末次随访时Cobb角、AVT、POA均显著小于术前（P＜0.05）。结论：退变性腰椎侧凸伴骨盆倾斜Ⅱ型患者术前骶骨和脊柱畸形比Ⅰ型更严重。对于Ⅰ型患者，纠正其Cobb角和AVT有助于其术后骨盆倾斜的改善。

英文摘要:

  【Abstract】 Objectives: To summarize the imaging characteristics of pelvic obliquity in patients with degenerative lumbar scoliosis(DLS), and to analyze the related imaging parameters and the outcome of pelvic obliquity after spinal correction surgery. Methods: The clinical data of 181 patients with DLS who underwent posterior scoliosis correction surgery in our hospital from January 2005 to December 2019 were retrospectively analyzed. There were 20 patients with pelvic obliquity before operation, aged 46-75 years(62.10±7.56 years). The follow-up time was 12-96 months(47.21±19.13 months). The C7 plumb line(C7PL) deviation direction of 15 patients was consistent with the higher side of the pelvic iliac crest, which was defined as type Ⅰ; The C7PL deviation direction of 5 patients was consistent with the lower side of the pelvic iliac crest, which was defined as type Ⅱ. The Cobb angle, coronal vertical axis(CVA), clavicle angle(CA), apical vertebral translation(AVT), sacral obliquity angle(SOA), and pelvic obliquity angle(POA), and clinical parameters such as apical vertebra position, fusion segment, the distal fixed vertebral position, and osteotomy method were collected before operation, after operation, and at the last follow-up and were compared within and between groups. Results: In type Ⅰ group, the Cobb angle, AVT, and POA after operation and at the last follow-up were significantly smaller than those before operation(P<0.05), and there was no significant difference in CVA, CA, and SOA compared with preoperative data(P>0.05). In type Ⅱ group, the postoperative AVT, Cobb angle, and POA were significantly smaller than those before operation(P<0.05), and there was no significant difference in CVA, CA, and SOA compared with preoperative data(P>0.05). At final follow-up, the SOA and AVT were significantly smaller than those before operation(P<0.05), and there was no significant difference in Cobb angle, CVA, CA, and POA compared with preoperative data(P>0.05). The preoperative SOA and AVT, postoperative Cobb angle, AVT and SOA at the last follow-up in type Ⅱ group were significantly higher than those in type Ⅰ group(P<0.05), and there was no significant difference in other radiological parameters between the two groups(P>0.05). In addition, there was no significant difference in clinical indicators such as the distal fixed vertebral position, apical vertebra position, fusion segment, and osteotomy method between the two groups(P>0.05). Persistent pelvic obliquity after operation occurred in 5 cases, and pelvic obliquity improved in 15 cases, with an improvement rate of 75%. The above mentioned imaging parameters of patients with persistent pelvic obliquity after operation and at the last follow-up were not significantly different from those before operation(P>0.05). The Cobb angle, AVT, and POA after operation and at final follow-up of patients with improved pelvic obliquity were significantly lower than those before operation(P<0.05). Conclusions: DLS and pelvic obliquity patients of type Ⅱ have more severe preoperative sacral and spinal deformities than those of type Ⅰ. For type Ⅰ patients, correction of Cobb angle and AVT is helpful for the improvement of pelvic obliquity after surgery.