腰后路减压复位环形融合治疗腰椎双节段椎体滑脱的临床疗效评估  

Clinical efficacy evaluation of posterior decompression and reduction and circular fusion for the treatment of lumbar double-segment spondylolisthesis

作　　者：王晟 李明 Wang Cheng;Li Ming(Department of Joint Trauma Surgery,First Affiliated Hospital of Hainan Medical College)

机构地区：[1]海南医学院第一附属医院关节创伤外科,海南570100

出　　处：《重庆医科大学学报》2022年第5期524-528,共5页Journal of Chongqing Medical University

基　　金：国家自然科学基金资助项目(编号:81260271)

摘　　要：目的:探讨腰椎后路减压复位环形融合治疗腰椎双节段椎体滑脱后临床疗效及腰椎-骨盆矢状位拟合关系的变化。方法:回顾性纳入2014年1月至2018年1月海南医学院第一附属医院关节创伤外科收治的接受腰椎后路减压复位环形融合内固定术且资料完整的67例双节段腰椎滑脱症患者。记录患者术前和末次随访时腰腿疼痛视觉模拟(visual analogue scale,VAS)评分及腰椎功能障碍指数(Oswestry disability index,ODI)评分,计算腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)及骨盆入射角(pelvic incidence,PI)并进行分析比较。结果:术后12个月,患者腰痛VAS评分由(5.1±0.6)分降至(2.1±0.5)分,ODI评分由(44.5±2.2)分降至(18.6±1.0)分,两者变化差异均具有统计学意义(P<0.001)。腰椎LL由47.3°±5.1°降至32.1°±6.0°,SS由40.3°±3.3°降至26.8°±7.5°,PT由34.5°±3.0°降至13.6°±5.0°,PI由63.2°±8.1°降至43.3°±6.6°,4个参数变化差异均有统计学意义(P<0.001)。术前LL与SS、PT及PI之间无明显相关性(P>0.05)。术后12个月时,LL与SS呈正相关性(P<0.05),SS与PT呈负相关性(P<0.05),SS与PI呈负相关性(P<0.05)。结论:腰椎后路减压复位环形融合内固定治疗腰椎双节段椎体滑脱有利于缓解患者腰腿痛,促进患者脊髓神经功能恢复,同时恢复腰椎-骨盆矢状位序列。Objective:To investigate the clinical effect of posterior decompression and reduction of lumbar spine and circular fusion for the treatment of lumbar double-segment spondylolisthesis and the changes in the sagittal fitting relationship between lumbar spine and pelvis.Methods:A total of 67 patients with double-segment lumbar spondylolisthesis who underwent posterior decompression,reduction,circular fusion and internal fixation of the lumbar spine in the Department of Joint Trauma Surgery,First Affiliated Hospital of Hainan Medical College from January 2014 to January 2018 were retrospectively included in this study.The patient's preoperative and final follow-up for lumbar and leg pain visual analogue scale(VAS)and lumbar spine dysfunction Oswestry disability index(ODI)scores were recorded,and their lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT)and pelvic incidence(PI)were determined and comparatively analyzed.Results:Twelve months after the operation,the VAS score of the patient's low back pain decreased from(5.1±0.6)points to(2.1±0.5)points,and the ODI decreased from(44.5±2.2)points to(18.6±1.0)points.The differences between the two changes were all statistically significant(P<0.001).LL decreased from 47.3°±5.1°to 32.1°±6.0°,SS decreased from 40.3°±3.3°to 26.8°±7.5°,PT decreased from 34.5°±3.0°to 13.6°±5.0°,and PI decreased from 63.2°±8.1°to 43.3°±6.6°,with significant differences among the four parameters(P<0.001).There was no significant correlation between LL and SS,PT and PI before operation(P>0.05).At 12 months postoperatively,LL was positively correlated with SS(P<0.05),SS was negatively correlated with PT(P<0.05),and SS was negatively correlated with PI(P<0.05).Conclusion:Posterior lumbar decompression,reduction,circular fusion and internal fixation for the treatment of lumbar double-segment spondylolisthesis is beneficial to alleviate lumbar and leg pain,promote the recovery of spinal nerve function,and re store the lumbar-pelvic sagittal alignment.

关 键 词：腰椎滑脱症 腰椎后路减压融合内固定 脊柱序列 

分 类 号：R687[医药卫生—骨科学]