退变性脊柱侧凸经骶2骶髂螺钉固定术后骨盆入射角的动态变化  

Dynamic changes of pelvic incidence after pelvic fixation with second sacral alar-iliac in patients with degenerative scoliosis

作　　者：胡宗杉 汤子洋 许彦劼 朱泽章[1] 邱勇[1] 刘臻[1] Hu Zongshan;Tang Ziyang;Xu Yanjie;Zhu Zezhang;Qiu Yong;Liu Zhen(Department of Spine Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Spine Surgery,Nanjing Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,南京210008 [2]南京医科大学鼓楼临床医学院脊柱外科,南京210008

出　　处：《中华骨科杂志》2022年第7期437-444,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(82072518)。

摘　　要：目的探讨退变性脊柱侧凸(degenerative scoliosis,DS)接受经骶2骶髂螺钉(second sacralalar-iliac,S2AI)固定术后随访期间骨盆入射角(pelvic incidence,PI)的变化,并分析与PI变化的可能相关因素。方法回顾性分析自2014年11月至2017年1月期间80例接受S2AI螺钉固定技术进行骨盆固定,且至少随访2年的DS患者病历资料,男30例(37.5%)、女50例(62.5%),年龄为(55.3±16.2)岁(范围38~73岁),随访时间为(34.6±8.7)个月(范围24~96个月)。根据术后即刻PI的变化将患者分为两组:PI降低<5°或升高(PI稳定组),共31例,男29例(93.5%)、女2例(6.5%),年龄(59.4±11.3)岁;PI下降>5°(PI活动组),共49例,男1例(2.0%)、女48例(98.0%),年龄(51.7±12.9)岁。在手术前后及术后2年测量以下影像学参数:PI、腰椎前凸角(lumbar lordosis,LL)、骨盆倾斜角(pelvictilt,PT)、PI-LL、脊柱矢状面平衡(sagittal vertical axis,SVA)。临床疗效评价采用脊柱侧凸研究学会-22简明量表调查问卷(Scoliosis Research Society questionnaires-22,SRS-22),并记录患者术中及术后随访期间的并发症发生情况。比较两组患者随访期间PI的变化情况。结果两组患者在年龄、性别、术前影像学参数及SRS-22的差异均无统计学意义(P>0.05)。术后PI稳定组31例(38.8%),PI从45.7°±11.4°降至45.3°±11.2°,差异无统计学意义;另49例(61.2%)为PI活动组,PI从51.6°±14.5°下降至40.9°±14.0°。末次随访时PI活动组中24例(49%)PI恢复(PI恢复组),增加幅度>5°;余25例(51%)无增加(PI保持组),平均ΔPI变化为-4.2°。分层分析显示PI恢复组与PI保持组的ΔPI、术后PI、术后PT和年龄的差异均有统计学意义。术前PI、术后PI、术后PT、术后PI-LL与末次随访时的ΔPI明显相关。Logistic回归分析显示术后PI是相关因素(OR=0.87,P=0.024)。结论DS患者应用S2AI螺钉固定技术进行骨盆固定术后即刻超过50%患者会发生PI下降,在术后至少2年的随访期间发生PI明显改变的患者�Objective To investigate how pelvic incidence(PI)would change during the follow-up in degenerative scoliosis(DS)patients who underwent second sacralalar-iliac(S2AI)fixation and identify the possible factors associated with the changes in PI.Methods The DS patients who underwent long fusion to pelvis with S2AI fixation with a minimum follow-up of two years between November 2014 to January 2017 were retrospectively reviewed in this study.The following sagittal radiographic parameters were measured,including pelvic incidence(PI),lumbar lordosis(LL),pelvic tilt(PT),PI minus LL(PI-LL),and sagittal vertical axis(SVA)at pre-operation,post-operation and 2-year follow-up.Patients were divided into two groups at immediate post-operation:PI decreased less than 5°or increased(Group PI stabilization);PI decreased larger than 5°(Group PI activity).Descriptive statistics were calculated for all patients in the form of mean value and standard deviation(SD).Comparisons of means between variables were performed using an unpaired Student's t test.Pearson correlation coefficienttest was performed to determine the correlations between all radiographic variables.Inter-and intra-observer reliability was assessed using intraclass correlation coefficient(ICC).The internal consistency of the measurements was characterized as excellent(ICC≥0.9),good(0.7≤ICC<0.9),acceptable(0.6<ICC≤0.7),poor(0.5≤ICC<0.6),or unpredictable(ICC<0.5).Results There were no significant differences in terms of age,sex,radiographic measurements and scores of SRS-22 between twogroups preoperatively(P>0.05).80 DS patients with a mean age of 55.3±16.2 years were enrolled in this study with a mean follow-up period of 34.6±8.7 months.At post-operation,39 patients(38.8%)were in group PI stabilization whose PI decreased from 45.7°±11.4°to 45.3°±11.2°with no significant difference;while the other 41(61.2%)were in group PI activity whose PI significantly decreased from 51.6°±14.5°to 40.9°±14.0°.At the last follow-up,24 patients(49%)in group PI activi

关 键 词：脊柱侧凸 骨盆 骶髂关节 骨螺丝 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]