基于Roussouly分型的脊柱-骨盆矢状面形态评估与腰椎融合术后邻椎病发生的关系研究  

Evaluation of spinopelvic alignment according to Roussouly classification can predict the occurrence of adjacent segment disease after lumbar fusion

作　　者：王牧一 王鑫 沈益飞 邱勇[2] 孙旭[2] 周栋 Wang Muyi;Wang Xin;Shen Yifei;Qiu Yong;Sun Xu;Zhou Dong(Department of Orthopedics,The Affiliated Changzhou Second People′s Hospital of Nanjing Medical University,Changzhou Medical Center,Nanjing Medical University,Changzhou 213000,China;Division of Spine Surgery,Department of Orthopedic Surgery,Affiliated Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Orthopedics,Changzhou Children′s Hospital,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州第二人民医院骨科,常州213000 [2]南京大学医学院附属鼓楼医院脊柱外科,南京210008 [3]常州市儿童医院骨科,常州213000

出　　处：《中华医学杂志》2023年第31期2412-2419,共8页National Medical Journal of China

基　　金：国家自然科学基金区域基金(82160555)

摘　　要：目的探讨基于Roussouly分型的脊柱‑骨盆矢状面形态评估与腰椎融合术后邻椎病(ASD)发生的关系。方法横断面研究。回顾性分析2009年1月至2019年1月因腰椎退变性疾病在南京医科大学附属常州第二人民医院和南京大学医学院附属鼓楼医院接受腰椎后路融合手术的166例腰椎退变性疾病患者的临床资料(随访时间不少于2年)。其中男59例,女107例,初次手术时的年龄为(58.6±9.5)岁(41~78岁),融合节段数为(1.7±0.7)个(1~3个)。将纳入患者按照“理论”(依据骨盆入射角(PI))和“实际[依据骶骨倾斜角(SS)]”Roussouly分型进行分类。若患者实际Roussouly分型与其理论分型相符合,则被定义为匹配;若不相符,则被定义为不匹配。对于单因素分析有统计学意义的结果,采用多因素logistic回归分析相关因素与ASD之间的关系。结果术后平均随访时间为(49.2±20.7)个月(25~134个月),30例(18.1%,30/166)患者被诊断为ASD。术后无ASD组中50例(36.8%,50/136)为不匹配状态,ASD组中20例(66.7%,20/30)为不匹配状态,差异有统计学意义(P=0.003)。单因素分析表明,高龄、融合节段数增加、漂浮固定、术前和术后较差的脊柱‑骨盆矢状面参数以及术后Roussouly分型不匹配为ASD的危险因素(均P<0.05)。多因素logistic回归分析发现,术后Roussouly分型不匹配(OR=3.310,95%CI:1.282~8.545,P=0.013)、高龄(OR=1.074,95%CI:1.019~1.131,P=0.008)和术后SS(OR=0.928,95%CI:0.865~0.995,P=0.036)为腰椎融合术后发生ASD的危险因素。结论腰椎融合术后脊柱‑骨盆矢状面参数与ASD发生有关联。基于Roussouly分型的脊柱‑骨盆矢状面评估对腰椎融合术后发生ASD有一定提醒价值。Objective To investigate the correlation of spinopelvic alignment according to Roussouly classification on the occurrence of adjacent segment disease(ASD)in the patients undergoing fusion surgery for lumbar degenerative diseases.Methods A cross‑sectional study.Clinical data of 166 consecutive patients who had undergone lumbar fusion between January 2009 and January 2019 in the Affiliated Changzhou Second People′s Hospital of Nanjing Medical University and Affiliated Drum Tower Hospital of Medical School of Nanjing University were retrospectively reviewed.There were 59 males and 107 females,with an average age of(58.6±9.5)years(ranged 41‑78 years).Fusion length averagely spanned(1.7±0.7)levels(ranged 1‑3 levels).The patients were classified by both"theoretical"(based on pelvic incidence(PI))and"current"(based on sacral slope(SS))Roussouly types.The patients were classified as"matched"if their"current"shape matched the"theoretical"type and otherwise as"unmatched".Multivariate logistic regression analysis of the variables recruited from univariate analyses was performed to identify the factors independently associated with the development of ASD after lumbar fusion.Results The average follow‑up duration after initial surgery was(49.2±20.7)months(ranged 25 to 134 months).Thirty(18.1%,30/166)patients were diagnosed as ASD.Postoperatively,two thirds of the patients who suffered ASD after surgery were unmatched,while 36.8%(50/136)of the patients without ASD had unmatched type.Univariate analyses showed that older age,more fusion levels,float fusion,pre‑and postoperative worse spinopelvic alignment,and postoperative unmatched Roussouly type were identified as risk factors of ASD.Multivariate logistic regression analysis identified postoperative Roussouly type mismatch(OR=3.310,95%CI:1.282-8.545,P=0.013),old age(OR=1.074,95%CI:1.019-1.131,P=0.008)and postoperative SS(OR=0.928,95%CI:0.865-0.995,P=0.036)as the independent risk factors of development of ASD after lumbar fusion.Conclusion A significant associat

关 键 词：脊柱融合术 腰椎 邻椎病 Roussouly分型 脊柱‑骨盆矢状面形态 腰椎融合 

分 类 号：R687.3[医药卫生—骨科学]