腰椎滑脱症患者术后腰痛与脊柱骨盆矢状位参数的相关性研究  

Correlation between postoperative back pain and spine-pelvic sagittal parameter in patients with lumbar spondylolisthesis

作　　者：任杭岭 赵一祥 张景涛[1] 徐大霞 宋娜[3] 张志 REN Hanging;ZHAO Yixiang;ZHANG Jingtao;XU Daxia;SONG Na;ZHANG Zhi(Department of Spinal Surgery,Liaocheng People’s Hospital,Liaocheng 252000,Shandong,China;Department of Orthopaedics,the First Clinical College of Shandong University,Jinan 250000,Shandong,China;Stem Cell and Regenerative Medicine Laboratory,Liaocheng People’s Hospital,Liaocheng 252000,Shandong,China)

机构地区：[1]聊城市人民医院脊柱外科,山东聊城252000 [2]山东大学第一临床学院骨科,山东济南250000 [3]聊城市人民医院干细胞与再生医学实验室,山东聊城252000

出　　处：《中国现代医生》2023年第21期50-53,59,共5页China Modern Doctor

摘　　要：目的 探讨腰椎滑脱症患者术后残余腰痛与脊柱骨盆矢状位参数变化的相关性。方法 回顾性分析2018年2月至2021年6月就诊于聊城市人民医院的L4单节段退变性腰椎滑脱症患者125例,所有患者均行椎旁肌间隙(Wiltse)入路经椎间孔椎体间融合术。术前及末次随访于腰椎侧位X线片上测量脊柱–骨盆矢状位参数: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)、滑脱度(slip percentage,SP),记录患者手术前后视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)。分析手术前后各参数差值与VAS评分、ODI改善率之间的相关性。结果 118例患者最终获平均1年以上的随访,其中37例患者末次随访时残存腰痛症状(VAS评分≥4分);对比术后残存腰痛与无腰痛患者(VAS评分<4分)的脊柱骨盆矢状位参数变化,发现术后残存腰痛症状患者除PI外,PT变化最小。Pearson相关分析显示,除PI外其余各参数的手术前后差值均与ODI、VAS评分改善率具有相关性(P<0.05),其中PT变化与临床疗效相关性最强。结论 腰椎滑脱症患者术后残存腰痛与脊柱骨盆矢状位参数具有相关性,其中PT变化与其相关性最强,手术过程中注重改善PT可减少术后腰痛的发生。Objective To explore the correlation between postoperative residual back pain and changes of spine-pelvic sagittal parameter in patients with lumbar spondylolisthesis.Methods A retrospective analysis was performed on 125 patients with L4 single-level degenerative lumbar spondylolisthesis admitted to Liaocheng People’s Hospital from February 2018 to June 2021.All patients were treated with transforaminal lumbar interbody fusion(TLIF)surgery through the paraspinal space(Wiltse)approach.Spinal-pelvic sagittal position parameters were measured on lateral lumbar radiographs before and at the last follow-up,including pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),lumbar lordosis(LL),slip percentage(SP),and the scores of visual analogue scale(VAS)and Oswestry disability index(ODI)before and after operation were recorded.The correlation between the changes of these parameters and the improve rates of VAS score and ODI was analyzed.Results 118 patients were followed up for an average of more than 1 year.At the last follow-up,37 patients had symptoms of back pain(VAS score≥4),comparing the changes of sagittal parameters of spine and pelvis between patients with residual back pain after operation and those without back pain(VAS score<4),it was found that the changes of PT in patients with residual back pain after operation were the smallest except PI.Pearson correlation analysis showed that the differences of other parameters before and after operation except PI were correlated with the improvement rate of ODI and VAS scores(P<0.05),and the change of PT had the strongest correlation with clinical efficacy.Conclusion Postoperative residual back pain in patients with lumbar spondylolisthesis is related to spine-pelvic sagittal parameters,among which PT is the most closely related,and reconstruction of PT during operation can achieve better surgical effect.

关 键 词：退变性腰椎滑脱症 Wiltse入路 经椎间孔椎体间融合术 腰痛 脊柱–骨盆矢状位参数 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]