单节段与双节段后路腰椎椎间融合后腰椎-骨盆矢状位参数的比较  

Comparison of lumbar-pelvic sagittal parameters after single-level and double-level posterior lumbar interbody fusion

作　　者：未洋洋 陈加成 孙珺 王秋安 袁峰 Wei Yangyang;Chen Jiacheng;Sun Jun;Wang Qiuan;Yuan Feng(Graduate School of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Orthopedics of Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学研究生院,江苏省徐州市221000 [2]徐州医科大学附属医院骨科,江苏省徐州市221000

出　　处：《中国组织工程研究》2020年第33期5300-5306,共7页Chinese Journal of Tissue Engineering Research

基　　金：江苏省科技厅项目(BE2016647),项目负责人:袁峰。

摘　　要：背景:后路腰椎椎间融合是治疗退变性腰椎滑脱症的经典术式,具有改善腰椎前凸角、增加椎间隙高度、复位滑脱椎体、提高患者生活质量等优势。目的:探讨单节段与双节段后路腰椎椎间融合治疗低度退变性腰椎滑脱症时对腰椎-骨盆矢状位参数的影响,分析改善腰椎-骨盆矢状位参数的影响因素。方法:回顾性分析2014年1月至2017年9月使用聚醚醚酮椎间融合器联合椎弓根螺钉系统行单节段与双节段后路腰椎椎间融合治疗低度(Ⅰ-Ⅱ度)退变性腰椎滑脱症68例患者的临床资料。根据手术融合节段分为2组,单节段组37例,双节段组31例。术前及末次随访时拍摄含双侧股骨头站立位腰椎侧位X射线片,比较2组患者腰椎-骨盆矢状位参数、术后融合器沉降率与骨性融合情况。结果与结论:①2组患者均顺利完成手术并进行随访,随访时间12-40个月;②单节段组与双节段组椎体滑移指数均较术前明显改善(P<0.05),2组间改善程度差异无显著性意义(P>0.05);③与术前相比,2组患者骨盆倾斜角显著减小(P<0.05),骶骨倾斜角显著增大(P<0.05),但2组之间差异无显著性意义(P>0.05);④与术前相比,2组患者腰椎前凸角、下腰椎前凸角、腰椎前凸分布指数明显增大(P<0.05),双节段组增加值显著大于单节段组(P<0.05);⑤与术前相比,2组患者L5入射角、L5椎体倾斜角、L1垂线与S1距离明显减小(P<0.05),且双节段组减小值显著大于单节段组(P<0.05);⑥2组患者融合器沉降率差异无显著性意义(P>0.05);末次随访时所有患者均获得骨性融合;⑦提示低度退变性腰椎滑脱症可通过后路腰椎椎间融合改善矢状位平衡,双节段融合后腰椎-骨盆矢状位参数改变更显著。BACKGROUND: Posterior lumbar intervertebral fusion is a classic surgical procedure for the treatment of degenerative lumbar spondylolisthesis. It has the advantages of improving lumbar lordosis, increasing the height of the intervertebral space, resetting the spondylolisthesis, and improving the quality of life of patients. OBJECTIVE: To investigate the effect of single-level and double-level posterior lumbar interbody fusion for low-grade degenerative lumbar spondylolisthesis on lumbar-pelvic sagittal parameters, and analyze the influencing factors of lumbar-pelvic sagittal parameters. METHODS: A retrospective analysis of 68 patients with degenerative lumbar spondylolisthesis treated with single-level or double-level low-grade(I-II degree) posterior lumbar interbody fusion using polyetheretherketone interbody fusion cage from January 2014 to September 2017 was conducted. According to the fusion segment, the patients were divided into single-level group(n=37) and double-level group(n=31). Before and at the last follow-up, X-ray films of lumbar spine with bilateral femoral head standing position were taken to compare the lumbar-pelvic sagittal parameters, the subsidence rate of fusion cage and bone fusion of the two groups. RESULTS AND CONCLUSION:(1) The patients in both groups successfully completed the operation and were followed up. All patients were followed up for 12-40 months.(2) The vertebral slip indexes in the single-level group and the double-level group were significantly improved compared with those before surgery(P<0.05), and there was no significant difference in the improvement between the two groups(P>0.05).(3) Compared with the preoperation, the pelvic tilt angle was significantly reduced(P<0.05), and the sacral slope was significantly increased(P<0.05), but the difference between the two groups was not statistically significant(P>0.05).(4) Compared with the preoperation, the lumbar lordosis, lower lumbar lordosis, and lumbar lordosis distribution index in the two groups were significantly increas

关 键 词：骨 退变性 腰椎 腰椎滑脱症 椎间融合 骨性融合 聚醚醚酮 骨盆 矢状位 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]