退行性腰椎管狭窄症患者行非融合减压手术对脊柱矢状面平衡的影响  

Effect of non-fusion decompression surgery on the sagittal balance of the spine in patients with degenerative lumbar spinal stenosis

作　　者：吴金伟 邹伟民[1] 许汉权[1] 吕海 WU Jinwei;ZOU Weimin;XU Hanquan;LU Hai(Department of Orthopaedics,Shunde Hospital of Guangzhou University of Traditional Chinese Medicine,Shunde 528388,China)

机构地区：[1]广州中医药大学顺德医院骨伤一科,广东顺德528388 [2]南方医科大学第三附属医院脊柱外科,广州510500

出　　处：《实用医学杂志》2018年第24期4127-4131,共5页The Journal of Practical Medicine

基　　金：佛山市医学类科技攻关项目(编号:201108210)

摘　　要：目的探讨退行性腰椎管狭窄症患者行非融合减压手术对脊柱矢状面平衡的影响。方法回顾性分析于2013年3月至2017年8月本研究组因退行性腰椎管狭窄症行非融合减压手术的患者共83例(非融合组),选取采用减压融合内固定手术的患者40例作为对照组,记录患者术前和术后1年的全脊柱X光侧位片结果,评估其术前及术后1年的脊柱参数包括矢状垂直轴(SVA),骨盆入射角(PI),骨盆倾斜(PT)和骶骨斜坡(SS),腰椎前凸(lumbar lordosis,LL)和胸椎后凸(TK),以及腰部VAS疼痛评分及ODI评分,对比不同术前脊柱矢状面失衡患者术后的临床效果。结果两组患者术后1年患者的VAS评分、ODI评分均较术前显著改善(P <0.001),且两组患者的PT、LL、TK角度均较术前显著增加,且SVA距离较术前显著减少,差异具有统计学意义(P <0.05),两组患者术前和术后1年的PI、SS、PT、LL和TK指标对比差异均无统计学意义(P> 0.05)。非融合患者中术后轻度组和重度组的SVA参数均显著较术前减小,差异具有统计学意义(P <0.05),且非融合组不同程度患者术后的LL角度均显著较术前提高(P <0.05),术后1年重度失衡组患者的VAS评分显著高于平衡组,差异具有统计学意义(P <0.05)。结论非融合减压手术对退行性腰椎管狭窄症患者能显著改善术前脊柱矢状面失衡,与融合手术效果相当,且脊柱矢状面失衡是影响术后疼痛的重要危险因素。Objective To investigate the effect of non-fusion decompression surgery on the sagittal balance of the spine in patients with degenerative lumbar spinal stenosis.Methods A retrospective analysis was performed from March 2013 to August 2017. A total of 83 patients(non-fusion group)underwent non-fusion decom-pression surgery in patients with degenerative lumbar spinal stenosis. 40 patients were used as a control group. The total spine X-ray lateral radiographs were recorded before and 1 year after surgery. The preoperative and postoperative 1 year spine parameters including sagittal vertical axis(SVA)and pelvic incidence were recorded. Angle (PI),pelvic tilt(PT)and tibial slope(SS),lumbar lordosis(LL)and thoracic kyphosis(TK),as well as lumbar VAS pain score and ODI score,comparing different preoperative sagittal clinical effect of postoperative imbalance in patients with facial imbalance.Results The VAS score and ODI score of the two groups were significantly improved after treatment for one year(P < 0.001),and the PT,LL,and TK angles of the two groups were signifi-cantly higher than those before surgery,and the SVA distance was significantly higher than that before surgery(P < 0.05). There were no significant differences in PI,SS,PT,LL and TK between the two groups before and 1 year after surgery(P > 0.05). The SVA parameters of the non-fusion patients in the mild and severe groups were significantly lower than those before the operation,the difference was statistically significant(P < 0.05). The LL angles of patients with different degrees of non-fusion group were significantly higher than those of preoperative group(P < 0.05). The VAS scores of patients with severe imbalance after 1 year were significantly higher than those of the balance group(P < 0.05).Conclusion Non-fusion decompression surgery can significantly improve the preoperative sagittal imbalance in patients with degenerative lumbar spinal stenosis,which is equivalent to the fusion surgery,and the sagittal imbalance of the spine is an important risk

关 键 词：腰椎管狭窄症 脊柱 矢状面 平衡 减压 

分 类 号：R687.3[医药卫生—骨科学]