脊柱-骨盆矢状面参数对腰椎间盘手术临床疗效的预测价值  

Value of spinal-pelvic sagittal plane parameters in predicting the clinical efficacy of lumbar disc herniation

作　　者：唐烨 卢圆圆 贾真 Ye Tang;Yuan-yuan Lu;Zhen Jia(Department of Orthopedics,The First Hospital of Changsha,Changsha,Hunan 410005,China;Orthopedic Medical Center,The First Affiliated Hospital of Hunan Normal University(Hunan Provincial People’s Hospital),Changsha,Hunan 410005,China)

机构地区：[1]长沙市第一医院脊柱外科,湖南长沙410005 [2]湖南师范大学附属第一医院(湖南省人民医院)骨科医学中心,湖南长沙410005

出　　处：《中国现代医学杂志》2020年第13期80-83,共4页China Journal of Modern Medicine

摘　　要：目的探讨术前脊柱-骨盆矢状面参数检测对腰椎间盘突出症患者手术临床疗效的判断价值。方法选取2017年1月-2018年3月长沙市第一医院和湖南省人民医院骨科腰椎间盘突出症患者90例作为研究对象。采用Quadrant通道下微创经椎间孔腰椎椎体间融合术(TLF)治疗腰椎间盘突出症,术前、术后均进行脊柱-骨盆矢状面检测,治疗后采用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)来评价临床及神经恢复效果,按照治疗效果分为治疗有效组与治疗无效组。结果以治疗效果为金标准,治疗有效66例,无效24例。脊柱-骨盆矢状面参数预测有效66例,无效24例,矢状面参数预测敏感性为93.9%,特异性为91.7%,准确性为93.3%,阳性预测值96.9%,阴性预测值为84.6%。经Kappa检验评估一致性,κ值为0.83。治疗前矢状面失平衡28例(31.1%),治疗后矢状面失平衡13例(14.4%),治疗前后比较,差异有统计学意义(P<0.05)。治疗后骶骨角(SS)、腰椎前凸(LL)和骨盆透射角(PI)较治疗前降低(P<0.05)。受试者工作特征(ROC)曲线下面积:骶骨角为0.860,腰椎前凸为0.867,骨盆透射角为0.592。术后2周VAS、ODI评分较术前降低(P<0.05)。结论脊柱-骨盆矢状面不平衡与腰椎退行性变有关,Quadrant通道下微创TLF术治疗腰椎间盘突出症效果佳,术前矢状面参数检测有助于预测术后疗效。Objective To evaluate the value of preoperative spinal-pelvic sagittal plane parameters in the diagnosis and treatment of lumbar disc herniation.Methods Ninety cases of patients with lumbar disc prolapsed were collected.Though Quadrant channel of minimally invasive by the intervertebral foramen between lumbar vertebral fusion(TLF),the treatment of lumbar intervertebral disc protrusion were performed.Before and after treatment,the spinal and pelvic sagittal plane detection,visual analog scale(VAS),Oswestry disability index(ODI)to evaluate the clinical and nerve recovery effect were recorded.According to the treatment effect,patients were divided into the effective group and ineffective group.Results Taking the treatment effect as the gold standard,the treatment was effective in 66 cases and ineffective in 24 cases.The spinal-pelvic sagittal plane parameters predicted that the treatment was effective in 66 cases and ineffective in 24 cases.The prediction sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the sagittal plane parameters were 93.9%,91.7%,93.3%,96.9%and 84.6%,respectively.The consistency was evaluated by Kappa test,and theκvalue was 0.83.There were 28 cases(31.1%)of sagittal imbalance before treatment and 13 cases(14.4%)of sagittal imbalance after treatment,and the difference between the two groups was statistically significant(P<0.05).Sacral slope,lumbar lordosis and pelvic incidence decreased after treatment compared with before treatment(P<0.05).The area under the ROC curves of sacral slope,lumbar lorexis and pelvic incidence were 0.860,0.867 and 0.592,respectively.VAS and ODI scores were significantly lower 2 weeks after surgery than before(P<0.05).Conclusion The increase of spinal-pelvic sagittal plane imbalance is related to the degenerative degeneration of lumbar spine.Minimally invasive TLF surgery through Quadrant channel for lumbar disc herniation has a good effect.

关 键 词：腰椎间盘突出症 经椎间孔腰椎椎体间融合术 脊柱-骨盆矢状面参数 疗效 

分 类 号：R687.3[医药卫生—骨科学]