轻中度老年腰椎峡部裂性椎体滑脱症患者骨盆平衡矫正情况与手术预后的相关性  

Correlationbetween pelvic balance correction and surgical prognosis in elderly patients with lumbar spondylospial spondylolisthesis

作　　者：杨波[1] 李冬月[2] 梁智林[1] 佟训哲 王健[1] 赵小林[1] 杜骁[1] 臧传义[1] YANG Bo;LI Dong-yue;LIANG Zhi-lin;TONG Xun-zhe;WANG Jian;ZHAO Xiao-lin;DU Xiao;ZANG Chuan-yi(Department of Orthopaedics,Beijing Geriatric Hospital,Beijing,100095;Department of Orthopaedics,Beijing Chao-Yang Hospital,Beijing,100043,China)

机构地区：[1]北京老年医院骨科,北京100095 [2]北京朝阳医院骨科,北京100043

出　　处：《颈腰痛杂志》2020年第4期408-411,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨轻中度老年腰椎峡部裂性椎体滑脱症患者骨盆平衡矫正情况与手术预后的相关性。方法选择2016年3月-2018年6月在北京老年医院和北京朝阳医院就诊的73例老年轻中度腰椎峡部裂性椎体滑脱的患者作为研究对象,手术前后对患者进行CT检查,进行矢状面和冠状面重建,测量骨盆倾斜角(pelvic tilt,PT)和骶骨前倾角(sacral slope,SS),根据PT和SS值,将骨盆分为平衡和失衡状态,根据手术前后骨盆平衡状态,将患者分为术前骨盆失衡(UPPBO)组和术前骨盆平衡(BPPBO)组。另根据术后骨盆平衡状态,将上述两组各分为组内的术后骨盆失衡(UPPAO)亚组和术后骨盆平衡(BPPAO)亚组。术前和术后采用VAS评分评估患者的疼痛程度、采ODI指数评估患者的腰部功能。比较UPPBO组和BPPBO组术后的骨盆失衡发生情况;另比较各亚组术后的VAS评分、ODI指数改善情况。同时,观察PT降低与术后VAS评分、手术前后VAS差值、术后ODI指数、手术前后ODI差值是否存在关联。结果UPPBO和BPPBO组患者术后UPPPAO、BPPAO的发生情况存在统计学差异(P<0.05)。根据UPPBO组患者的术后骨盆平衡状态,该组术后UPPAO和BPPAO亚组患者VAS、ODI评分的术前、术后、差值相比较,差异均无统计学意义(P>0.05);根据BPPBO组患者术后骨盆平衡状态,该组术后UPPAO和BPPAO亚组患者VAS、ODI评分的术前、术后、差值相比较,差异均无统计学意义(P>0.05)。本研究中,术后UPPAO和BPPAO组患者VAS、ODI评分的术前、术后和差值相比较,差异均无统计学意义(P>0.05)。Spearman相关显示,PT差值与患者术后VAS、ODI及VAS差值、ODI差值均无相关性(P>0.05)。结论老年人轻中度峡部裂腰椎滑脱的临床预后与术后骨盆平衡状态改变和术后PT降低均无相关性;应侧重手术减压融合固定以解除神经压迫和重建腰椎稳定性,而不应过度追求对骨盆平衡的纠正。Objective To investigate the correlation between pelvic balance correction and surgical prognosis in elderly patients with lumbar spondylospial spondylolysis.Methods From March 2016 to June 2018,73 elderly patients with mild to moderate spondylolysis spondylolisthesis in Beijing Geriatric Hospital and Beijing Chaoyang Hospital were selected as the research objects.Before and after operation,CT examination was performed on the patients,sagittal and coronal reconstruction were performed.Pelvic tilt(PT)and sacral slope(SS)were measured,According to the pelvic balance before and after operation,the patients were divided into preoperative pelvic imbalance(UPPBO)group and preoperative pelvic balance(BPPBO)group.In addition,according to the status of postoperative pelvic balance,the two groups were divided into the postoperative pelvic imbalance(UPPAO)subgroup and the postoperative pelvic balance(BPPAO)subgroup.VAS score was used to evaluate the degree of pain before and after operation,and ODI index was used to evaluate lumbar function.The incidence of pelvic imbalance was compared between uppbo group and bppbo group,and the VAS score and ODI index of each subgroup were compared.At the same time,the relationship between Pt decrease and postoperative VAS score,VAS difference before and after operation,ODI index after operation and ODI difference before and after operation were observed.Results The incidence of UPPPAO and BPPAO was significantly different between UPPBO group and BPPBO group(P<0.05).According to the postoperative pelvic balance state of patients in UPPBO group,there was no significant difference in VAS and ODI scores between UPPAO and BPPAO subgroups(P>0.05);according to the postoperative pelvic balance state of patients in BPPBO group,there was no significant difference in VAS and ODI scores between UPPAO and BPPAO subgroups(P>0.05).In this study,there was no significant difference in VAS and ODI scores between UPPAO and BPPAO groups before,after and after operation(P>0.05).Spearman correlation showed th

关 键 词：峡部裂 腰椎滑脱 骨盆平衡 临床预后 

分 类 号：R681.5[医药卫生—骨科学]