腰椎滑脱症患者手术前后脊柱-骨盆矢状位参数变化与临床疗效的相关性分析  

CORRELATION ANALYSIS OF CHANGES OF SPINE-PELVIC SAGITTAL PARAMETERS BEFORE AND AFTER OPERATION AND EFFECTIVENESS IN PATIENTS WITH LUMBAR SPONDYLOLISTHESIS

作　　者：任杭岭 耿伟[1,2] 马金柱[1,2] 徐辉[1,2] 李忠[1,2] 庞良龙[1,2] 李昆朋[1,2] 

机构地区：[1]泰山医学院聊城临床学院 [2]聊城市人民医院脊柱外科,山东聊城252000

出　　处：《中国修复重建外科杂志》2015年第10期1269-1274,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨腰椎滑脱症患者手术前后脊柱-骨盆矢状位参数变化与临床疗效之间的相关性。方法回顾性分析2011年6月-2014年1月符合选择标准的L4单节段退变性腰椎滑脱症患者32例,其中男13例,女19例;年龄51-67岁,平均59岁。腰椎滑脱Meyerding分度：Ⅰ度21例,Ⅱ度10例,Ⅲ度1例。所有患者均行经椎间孔腰椎椎体间融合术。另选取35名健康成年人作为正常对照组,其中男17例,女18例;年龄46-67岁,平均57岁。术前及末次随访摄站立位（包括T12-S1、双侧股骨头）腰椎侧位X线片,测量骨盆入射角（pelvic incidence,PI）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）、腰椎前凸角（lumbar lordosis,LL）、椎间隙高度（disc height,DH）、滑脱度（slip percentage,SP）,并对患者进行疼痛视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评定。分析术前各脊柱-骨盆矢状位参数间及其与ODI、VAS评分间的相关性,并分析手术前后各参数差值与VAS评分、ODI改善率间的关系。结果 研究组患者均获随访,随访时间15-22个月,平均18个月。末次随访时,VAS评分、ODI较术前显著改善（P〈0.05）;脊柱-骨盆矢状位参数除PI与术前比较差异无统计学意义（t=—1.445,P=0.158）外,PT、SS、LL、SP、DH均较术前显著改善（P〈0.05）。末次随访时,研究组除PI大于正常对照组（t=8.531,P=0.043）外,PT、SS、LL、DH与正常对照组比较差异均无统计学意义（P〉0.05）。Pearson相关分析显示,术前脊柱-骨盆矢状位参数中PI、PT、SS、LL间均相关（P〈0.05）。术前除LL、DH外,其余各参数均与ODI和VAS评分相关（P〈0.05）。除PI外,其余各参数手术前后差值均与ODI、VAS评分改善率相关（P〈0.05）,其中PT与ODI、VAS评分改善率间相关性最强。结论 腰椎滑脱症患者手术前后脊柱-骨盆矢状位参数的变化与临床疗效具有相关性,其中PT与ODI、VAS评分改善率�Objective To investigate the correlation between the effectiveness and the changes of spine-pelvic sagittal parameters for patients with spondylolisthesis before and after operation. Methods A retrospective analysis was made on the clinical data of 32 patients with single segmental degenerative lumbar spondylolisthesis at L4 who accorded with the inclusion criteria between June 2011 and January 2014 （trial group）. There were 13 males and 19 females, aged 51-67 years （mean, 59 years）. According to Meyerding degree, there were 21 cases of degree I, 10 cases of degree II, and 1 case of degree III. All patients were treated with transforaminal lumbar interbody fusion （TLIF） surgery. Thirty-five healthy adults at the age of 46-67 years （mean, 57 years） were enrolled as normal controls （control group）. The standing position lumbar lateral X-ray films （T12-S1, bilateral femoral head） were taken at pre- and post-operation to measure the pelvic incidence （PI）, pelvic tilt （PT）, sacral slope （SS）, lumbar lordosis （LL）, disc height （DH）, and slip percentage （SP）; the visual analogue scale （VAS） and Oswestry disability index （ODI） were recorded. Pearson correlation analysis was used to analyze the correlation between the preoperative various spine-pelvic sagittal parameters and the VAS score and the ODI. After operation, Pearson correlation analysis was used to evaluate the correlation between the changes of these parameters and the improve rates of VAS score and ODI. Results All patients of trial group were followed up 15-22 months （mean, 18 months）. At last follow-up, the VAS score, ODI, PT, SS, LL, SP, and DH were significantly improved when compared with preoperative values （P〈0.05）, except for PI （t= — 1.445, P=0.158）. There was no significant difference in PT, SS, LL, and DH between trial and control groups at last follow-up （P〉0.05）; PI was slightly bigger than that of control group （t=8.531, P=0.043）. Pearson correlation analysis showed

关 键 词：退变性腰椎滑脱症 脊柱-骨盆矢状位参数 经椎间孔腰椎椎体间融合术 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]