退变性腰椎侧凸伴骨盆倾斜的影像学特征及矫形术后转归  

Imaging features and postoperative outcomes in patients with degenerative lumbar scoliosis and pelvic obliquity

作　　者：李君禹 李危石[1] 于淼[1] 曾岩[1] 王永强[1] 孙卓然[1] 周思宇 LI Junyu;LI Weishi;YU Miao(Department of Orthopedics,Peking University Third Hospital,Engineering Research Center of Bone and Joint Precision Medicine,Beijing Key Laboratory of Spinal Disease Research,Beijing,100191,China)

机构地区：[1]北京大学第三医院骨科骨与关节精准医学教育部工程研究中心、脊柱疾病研究北京市重点实验室,北京市100191

出　　处：《中国脊柱脊髓杂志》2023年第3期213-218,共6页Chinese Journal of Spine and Spinal Cord

基　　金：国家自然科学基金面上项目(81871807)。

摘　　要：目的:总结退变性腰椎侧凸患者伴骨盆倾斜的影像学特征,并分析脊柱矫形术后相关的影像学参数和骨盆倾斜的转归.方法:回顾性分析2005年1月~2019年12月在我院行后路脊柱侧凸矫形内固定融合手术的181例退变性腰椎侧凸患者的临床资料.术前合并骨盆倾斜20例,年龄46~75岁(62.10±7.56岁),随访时间12~96个月(47.21±19.13个月).15例患者C7铅垂线(C7PL)偏移方向与骨盆髂嵴较高侧保持一致,定义为Ⅰ型;5例患者C7PL偏移方向与骨盆髂嵴较低侧一致,定义为Ⅱ型.收集患者术前、术后即刻及末次随访时的Cobb 角、冠状位平衡(coronal vertical axis,CVA)、锁骨角(clavicle angle,CA)、顶椎偏距(apical vertebral trans-lation,AVT)、骨倾斜角(sacral obliquity angle,SOA)、骨盆倾斜角(pelvic obliquity angle,POA)等影像学参数以及顶椎位置、融合节段、截骨方式、远端固定椎位置等临床指标,并进行组内比较与组间比较.结果:Ⅰ型组术后及末次随访时的Cobb角、AVT、POA均显著小于术前(P<0.05),CVA、CA和SOA与术前比较均无统计学差异(P>0.05).Ⅱ型组术后Cobb角、AVT、POA显著小于术前(P<0.05),CVA、CA、SOA与术前比较均无明显差异(P>0.05);末次随访SOA、AVT显著小于术前(P<0.05),Cobb角、CVA、CA、POA与术前比较无统计学差异(P>0.05).Ⅱ型组术前SOA与AVT、术后Cobb角及末次随访时AVT与SOA均显著大于Ⅰ型组(P<0.05),其他影像学参数两组间比较无显著性差异(P>0.05).Ⅰ型组与Ⅱ型组远端固定椎、顶椎位置、融合节段数、截骨方式等临床指标无明显差异(P>0.05).术后骨盆持续倾斜5例,骨盆倾斜改善15例,改善率75%.术后骨盆持续倾斜患者术后及末次随访时上述影像学参数较术前无显著性差异(P>0.05);术后骨盆倾斜改善组术后及末次随访时Cobb角、AVT、POA均显著小于术前(P<0.05).结论:退变性腰椎侧凸伴骨盆倾斜Ⅱ型患者术前骶骨和脊柱畸形比Ⅰ型更严重.对于Objectives:To summarize the imaging characteristics of pelvic obliquity in patients with degener-ative lumbar scoliosis(DLS),and to analyze the related imaging parameters and the outcome of pelvic obliquity after spinal correction surgery.Methods:The clinical data of 181 patients with DLS who underwent posterior scoliosis correction surgery in our hospital from January 2005 to December 2019 were retrospectively ana-lyzed.There were 20 patients with pelvic obliquity before operation,aged 46-75 years(62.10±7.56 years).The follow-up time was 12-96 months(47.21±19.13 months).The C7 plumb line(C7PL)deviation direction of 15 patients was consistent with the higher side of the pelvic iliac crest,which was defined as type I;The C7PL deviation direction of 5 patients was consistent with the lower side of the pelvic iliac crest,which was defined as type II.The Cobb angle,coronal vertical axis(CVA),clavicle angle(CA),apical vertebral translation(AVT),sacral obliquity angle(SOA),and pelvic obliquity angle(POA),and clinical parameters such as apical vertebra position,fusion segment,the distal fixed vertebral position,and osteotomy method were collected before operation,after operation,and at the last follow-up and were compared within and between groups.Results:In type I group,the Cobb angle,AVT,and POA after operation and at the last folow-up were significantly smaller than those before operation(P<0.05),and there was no significant difference in CVA,CA,and SOA compared with preoperative data(P>0.05).In type I group,the postoperative AVT,Cobb angle,and POA were significantly smaller than those before operation(P<0.05),and there was no significant difference in CVA,CA,and SOA compared with preoperative data(P>0.05).At final follow-up,the SOA and AVT were significantly smaller than those before operation(P<0.05),and there was no significant difference in Cobb angle,CVA,CA,and POA compared with preoperative data(P>0.05).The preoperative SOA and AVT,postoperative Cobb angle,AVT and SOA at the last follow-up in type II group we

关 键 词：退变性腰椎侧凸 骨盆倾斜 影像学参数 矫形手术 矫形策略 

分 类 号：R682.3[医药卫生—骨科学] R687.3[医药卫生—外科学]