复位与原位椎间融合固定治疗退行性腰椎滑脱  

The effect of reduction and in situ fusion on postoperative imaging parameters of degenerative lumbar spondylolisthesis

作　　者：史浩冉 刘涛[1] 王悦勇 周浩盛 丁壮志 关海山[1] Shi Haoran;Liu Tao;Wang Yueyong;Zhou Haosheng;Ding Zhuangzhi;Guan Haishan(Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华骨科杂志》2023年第15期999-1006,共8页Chinese Journal of Orthopaedics

摘　　要：目的 比较复位与原位椎间融合固定治疗退行性腰椎滑脱的疗效.方法 回顾性分析2019年1月至2022年12月于山西医科大学第二医院脊柱外科接受后路L4.5内固定、椎体间融合治疗的Meyerding分型Ⅰ度及Ⅱ度的L退行性腰椎滑脱患者182例,男92例、女90例,年龄(62.6±6.8)岁(范围57~73岁).Ⅰ度滑脱105例、Ⅱ度滑脱77例.根据手术方式分为复位椎间融合固定(复位组)和原位椎间融合固定(原位固定组).测量手术前后腰椎侧位X线片的腰椎前凸角(lumber lordosis,LL)及其与骨盆入射角(pelvic incidence,PI)的差值、L3.4椎间隙高度、融合节段成角、矢状垂直轴(sagittal vertical axis,SVA)等影像学参数.记录手术前后腰痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(Oswestry disability index,ODI),比较复位与原位融合术后临床及影像学指标的差异.结果 182例患者均顺利完成手术并获得随访,随访时间(12.0±2.4)个月(范围9~15个月).复位组术前、术后即刻、末次随访的LL分别为46.9°±7.1°、57.2°± 5.9°、55.6°±5.5°,差异有统计学意义(F=87.61;P<0.001),其中术后及末次随访均小于原位固定组;原位固定组术前、术后即刻、末次随访的LL分别为47.8°±7.2°、50.5.±7.0°、48.7.±6.4°,差异无统计学意义(F=2.83,P=0.062).复位组术后即刻及末次随访的LL均小于原位固定组(P<0.05).复位组术前、术后即刻、末次随访的融合节段成角分别为14.2°±5.1°、23.2.± 4.7°、23.2°±4.7°,差异有统计学意义(F=152.87,P<0.001),其中术后即刻及末次随访均大于术前;原位固定组术前、术后即刻、末次随访的融合节段成角分别为15.4°±5.9°、18.2°±5.5°、17.4°±5.1°,差异有统计学意义(F=4.69,P=0.009),其中术后即刻及末次随访均大于术前.复位组术后即刻及末次随访的融合节段成角均大于原位固定组(P<0.05).复位组术前、术后即刻、末次随访的SVA分别为(16.9±18.Objective To compare the efficacy of reduction and in situ intervertebral fusion fixation in the treatment of degenerative lumbar spondylolisthesis.Methods A total of 182 patients(92 males and 90 females)with L4 degenerative lumbar spondylolisthesis of Meyerding's classification of grade I and grade II,aged(62.6±6.8)years(range,57-73 years),who underwent posterior L4,5 internal fixation and interbody fusion in the Department of Spinal Surgery,the Second Hospital of Shanxi Medical University,were retrospectively analyzed from January 2019 to December 2022.There were 105 cases of I-degree spondylolisthesis and 77 cases of II-degree spondylolisthesis.According to the operation method,the patients were divided into reduction intervertebral fusion fixation(reduction group)and in situ intervertebral fusion fixation group(in situ group).Imaging parameters such as lumber lordosis(LL),pelvic incidence(PI)-LL,L3,4 intervertebral space heights,fusion segment angle,and sagittal vertical axis(SVA)were measured on the pre-and post-surgical lumbar spine lateral radiographs.The visual analogue scale(VAS)and Oswestry Disability Index(ODI)of low back pain were recorded before and after surgery.The differences in clinical and imaging parameters were compared between reduction and in situ fusion group.Results All 182 patients successfully completed the surgery and were followed up for 12.0±2.4 months(range,9-15 months).The LL of the reduction group before surgery,immediately after surgery,and at the last follow-up were 46.9°±7.1°,57.2°±5.9°,55.6°±5.5°,respectively,with statistically significant differences(F=87.61,P<0.001),with immediate and final follow-up being smaller than those in the in situ fixation group.The LL of the in situ fixation group before surgery,immediately after surgery,and at the last follow-up were 47.8°±7.2°,50.5°±7.0°,and 48.7°±6.4°,respectively,with no statistically significant difference(F=2.83,P=0.062).The immediate and final follow-up of LL in the reduction group was lower than those in

关 键 词：腰椎 脊柱滑脱 腰椎融合术 放射学 

分 类 号：R687.3[医药卫生—骨科学]