斜外侧腰椎椎间融合术后脊柱-骨盆矢状位参数变化与临床疗效的相关性研究  

Relationship between alterations of spine-pelvic sagittal parameters and clinical outcomes after oblique lumbar interbody fusion

作　　者：孙秀民 徐宏光[1] 肖良[1] 刘晨 杨晓明[1] 赵泉来[1] 聂文磊 SUN Xiu-min;XU Hong-guang;XIAO Liang;LIU Chen;YANG Xiao-ming;ZHAO Quan-lai;NIE Wen-lei(Spine Surgery Research Center of Wannan Medical College,Department of Spine Surgery,Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院脊柱外科研究中心皖南医学院弋矶山医院脊柱骨科,安徽芜湖241001

出　　处：《中国骨伤》2020年第7期609-614,共6页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金面上项目(编号:81972108);皖南医学院弋矶山医院科技创新团队“攀峰”培育计划(编号:PF2019007);皖南医学院弋矶山医院科研能力“高峰”培育计划项目(编号:GF2019T02,GF2019G07,GF2019G12)。

摘　　要：目的:探讨斜外侧腰椎椎间融合术(oblique lumbar interbody fusion,OLIF)手术前后脊柱-骨盆矢状位参数变化以及与其临床疗效的相关性。方法:回顾性分析2017年7月至2018年7月采用OLIF(Stand-Alone)手术治疗的65例腰椎退行性疾病患者的临床资料,男26例,女39例;年龄33~79(62.72±10.23)岁。评估患者术前及末次随访时Oswestry功能障碍指数(Oswestry Disability Index,ODI)与视觉模拟评分(visual analogue scale,VAS)。测量术前及末次随访时手术节段椎间隙高度(disc height,DH)及脊柱-骨盆矢状位参数,包括骨盆入射角(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)。根据PI-LL的差值判断PI与LL是否匹配并将患者进行分组,PI-LL数值位于-9°~9°之间设为匹配组,数值<-9°或>9°设为失匹配组。分析腰椎退行性疾病患者行OLIF术前及末次随访时脊柱-骨盆矢状位参数变化,比较其变化与临床疗效之间的相关性。结果:所有患者获得随访,时间8~20(14.20±3.68)个月。65例患者手术时间(91.54±25.97)min,术中出血量(48.15±10.14)ml,住院时间6~19(9.28±2.50)d。手术节段共计84个,单节段46例,双节段19例。VAS评分和ODI分别由术前的(4.88±0.99)分、(67.60±13.73)%改善至末次随访时的(2.85±1.30)分、(30.57±6.48)%,差异均有统计学意义。矢状位参数LL、PT、SS、PI、PI-LL及手术节段DH分别由术前的(42.80±16.35)°、(23.22±10.91)°、(26.95±13.30)°、(50.22±14.51)°、(7.53±16.13)°、(0.91±0.29)cm改善至末次随访时的(49.95±12.82)°、(17.94±9.24)°、(33.71±12.66)°、(51.65±10.26)°、(1.68±17.00)°、(1.20±0.40)cm,术前与末次随访时LL、PT、SS、PI-LL、DH比较差异均有统计学意义,而PI比较差异无统计学意义。术前PI-LL匹配组LL为(48.76±11.09)°,PI-LL失匹配组LL为(38.00±18.37)°,差异有统计学意义;VAS、ODI、PT、SS、PI、DH组间比较差异均无统计学意义。�Objective:To investigate the relationship between spine-pelvic sagittal parameters and clinical efficacy before and after oblique lumbar interbody fusion(OLIF).Methods:A retrospective analysis of clinical data of 65 patients with lumbar degenerative diseases treated with OLIF were performed from July 2017 to July 2018.There were 26 males and 39 females aged from 33 to 79 years old with an average of(62.72±10.23)years old.Oswestry Disability Index(ODI)and visual analogue scale(VAS)before and at the latest follow-up were evaluated.Disc height(DH)and spine-pelvic sagittal parameters of the surgical segment were measured before and at the latest follow-up,including pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)and lumbar lordosis(LL).According to the difference of PI-LL,it was judged whether PI and LL match and the patients were grouped,PI-LL ranged from-9°to 9°was set as matching group,and PI-LL less than-9°or larger than 9°was set as mis matching group.The spine-pelvic sagittal parameters were analyzed before and at the latest follow-up of OLIF in patients with lumbar degenerative diseases,and the correlation between changes and clinical efficacy was compared.Results:All patients were followed up from 8 to 20 months with an average of(14.20±3.68)months.Operation time was(91.54±25.97)min,intraoperative blood loss was(48.15±10.14)ml,and the hospitalization time ranged from 6 to 19 days with an average of(9.28±2.50)days.Totally 84 surgical levels,46 patients were single segment and 19 patients were double segments.VAS and ODI score were improved from(4.88±0.99)point,(67.60±13.73)%preoperatively to(2.85±1.30)points,(30.57±6.48)%at the latest follow-up.There were significant differences in VAS and ODI scores between before and at the latest follow-up.The sagittal parameters of LL,PT,SS,PI,PI-LL and the surgical level DH were(42.80±16.35)°,(23.22±10.91)°,(26.95±13.30)°,(50.22±14.51)°,(7.53±16.13)°,(0.91±0.29)cm preoperatively and improved to the latest follow-up(49.95±12.82)°,(17.94±9.24

关 键 词：脊柱融合术 椎间盘退行性变 骨盆 脊柱 

分 类 号：R681.5[医药卫生—骨科学]