基于核心弯的退变性腰椎侧凸冠状面失衡分型的临床应用效果  

Clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis

作　　者：孙文志 王宝宝[1] 胡海量[1] 孔超 朱卫国 陈小龙 潘福敏 王鹏[1] 张思韬 鲁世保[1] Sun Wenzhi;Wang Baobao;Hu Hailiang;Kong Chao;Zhu Weiguo;Chen Xiaolong;Pan Fumin;Wang Peng;Zhang Sitao;Lu Shibao(Department of Orthopedics,Xuanwu Hospital,Capital Medical University,National Clinical ResearchCenter for Geriatric Diseases,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院骨科,国家老年疾病临床医学研究中心,北京100053

出　　处：《中华医学杂志》2023年第15期1119-1126,共8页National Medical Journal of China

基　　金：国家重点研发计划(2020YFC2004900);北京市医院管理中心临床医学发展专项(XMLX202126);北京市教育委员会科技/社科计划(KZ202210025038)

摘　　要：目的介绍一种基于核心弯的退变性腰椎侧凸冠状面失衡分型方法的临床应用效果。方法病例系列研究。回顾性分析2019年1月至2021年1月在首都医科大学宣武医院行后路脊柱矫形手术的61例退变性腰椎侧凸患者的临床资料,其中男8例,女53例,年龄(71.7±6.2)岁(60~82岁)。根据冠状面C_(7)铅垂线(C_(7)PL)偏离骶骨正中线(CSVL)的方向以及L_(4)椎体倾斜方向来判断核心弯:若C_(7)PL的偏离CSVL方向与胸腰弯凹侧一致,L_(4)椎体倾斜方向与C_(7)PL偏离CSVL方向相反,则胸腰弯为核心弯,定义为1型;若C_(7)PL偏离CSVL的方向与腰骶弯凹侧一致,L_(4)椎体倾斜方向与C_(7)PL偏离CSVL方向一致,则腰骶弯为核心弯,定义为2型。根据冠状面平衡距离(CBD)的绝对值(|CBD|)分别将每一型患者分为两组,即|CBD|≤3 cm的平衡组(CB)与|CBD|>3 cm的失衡组(CIB)。记录并分析术前术后胸腰弯Cobb角、腰骶弯Cobb角以及CBD变化。结果61例患者(1型23例,2型38例)中术前冠状面失衡发生率为55.7%(34/61),1型中为34.8%(8/23),2型中为68.4%(26/38),术后冠状面失衡发生率为27.9%(17/61),1型组为13.0%(3/23),2型组为36.8%(14/38)。1型术后CB组|CBD|为(1.5±1.0)cm,较术前的(2.6±1.4)cm减小(P=0.015);胸腰弯的矫正率为68.8%±18.4%,明显大于腰骶弯的矫正率(34.5%±23.9%),差异有统计学意义(P=0.005)。2型术后CB组|CBD|为(1.6±1.2)cm较术前的(2.6±3.0)cm明显减小(P=0.027);腰骶弯的矫正率为71.3%±18.6%,大于胸腰弯的57.3%±21.1%,但差异无统计学意义(P=0.546),2型术后CIB组|CBD|与术前差异无统计学意义(P=0.222),腰骶弯的矫正率为38.3%±14.8%,小于胸腰弯的53.6%±16.0%,差异有统计学意义(P=0.001)。1型术后CB组患者CBD变化(3.8±1.5)cm与两弯矫正率之差(32.3%±19.6%)存在相关性(r=0.904,P<0.001)。2型术后CB组CBD变化(1.9±2.2)cm与两弯矫正率之差(14.0%±26.2%)存在相关性(r=0.960,P<0.001)。结论基于核心弯的退变性腰椎侧凸冠状�Objective To present efficacy of clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis(DLS).Methods A case series study.Clinical data of 61 cases(8 males,53 females)who underwent posterior correction surgery for DLS from January 2019 to January 2021 were retrospectively analyzed.The mean age was(71.7±6.2)years(ranged 60-82 years).According to the direction of C_(7)plumb line(C_(7)PL)deviated from central sacral vertical line(CSVL)and orientation of L_(4)coronal tilt,the author determined which one was the crucial curve.If C_(7)PL deviated from CSVL in the same direction as concave side of the thoracolumbar curve and L_(4)coronally tilts opposite direction of C_(7)PL deviates from CSVL,then the crucial curve was thoracolumbar curve(type 1).On the contrary,if C_(7)PL deviated from CSVL in the same direction as concave side of the lumbosacral curve and L_(4)coronally tilts consist with direction of C_(7)PL deviates from CSVL,then the crucial curve was lumbosacral curve(type 2).According to absolute value of coronal balance distance(|CBD|),each type of patients was divided into two groups,respectively,namely coronal balance(CB)(|CBD|≤3 cm)and coronal imbalance(CIB)(|CBD|>3 cm).Changes of Cobb angles of thoracolumbar curve and lumbosacral curve and CBD were recorded and analyzed.Results The rate of preoperative CIB was 55.7%(34/61)in all the patients.Of the patients,23 cases were classified as type 1 and 38 cases as type 2.The rate of preoperative CIB was 34.8%(8/23)in type 1 patients and 68.4%(26/38)in type 2.The rate of postoperative CIB was 27.9%(17/61)in all the patients,with 13.0%(3/23)in type 1 and 36.8%(14/38)in type 2.The|CBD|of CB group in type 1 patients decreased from(2.6±1.4)cm before the operation to(1.5±1.0)cm after(P=0.015);and the correction rate of thoracolumbar curve(68.8%±18.4%)was significantly higher than that of lumbosacral curve(34.5%±23.9%)(P=0.005).The|CBD|of CB group in type 2 patients decreased from(2.6±3.0)cm before

关 键 词：脊柱侧凸 退变性腰椎侧凸 冠状面平衡 分型 核心弯 矫正率 

分 类 号：R687.3[医药卫生—骨科学]