腰椎滑脱融合术后腰骶矢状位参数对腰椎手术失败综合征发生的影响  

Analysis of lumbosacral sagittal balance and failed back surgery syndrome in patients with lumbar posterior intervertebral fusion and degenerative lumbar slide removal

作　　者：薛雷雷 魏戎 武军龙 XUE Lei-lei;WEI Rong;WU Jun-long(Department of Orthopedics,Luoyang Central Hospital Affiliated to Zhengzhou University,Luoyang,Henan 471000,China)

机构地区：[1]郑州大学附属洛阳中心医院骨科,河南洛阳471000

出　　处：《颈腰痛杂志》2023年第5期762-766,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨退行性腰椎滑脱症(DLS)患者后路椎间融合(PLIF)手术后腰骶矢状位平衡参数对腰椎手术失败综合征(FBSS)发生的影响。方法选择2017年1月~2019年8月在本院接受后路椎间融合术治疗的DLS患者作,手术前后测量腰椎前凸角(LL)、节段性前凸角(SL)、骶骨倾斜角(SS)、椎间盘高度(HOD)、骨盆入射角(PI)和骨盆倾斜角(PT),评估患者疼痛VAS评分和ODI指数,观察腰骶矢状位平衡参数与FBSS的相关性。结果术后患者VAS评分和ODI指数均较术前显著降低(P<0.05)。FBSS发生率为19.47%。FBSS患者体质量指数≥24 kg/m^(2)、症状持续时间、侧隐窝狭窄、合并焦虑、合并抑郁、手术时间高于非FBSS(P<0.05)。FBSS组患者术后SL、SL矫正度(ΔSL)、VAS改善度(ΔVAS)、ODI改善度(ΔODI)均显著低于非FBSS患者(P<0.05),术后PT、PT矫正度(ΔPT)、术后VAS、术后ODI均显著高于非FBSS患者(P<0.05)。多因素Logistic回归分析显示,症状持续时间、侧隐窝狭窄、ΔPT是FBSS的风险因素(P<0.05)。相关性分析显示,ΔVAS和ΔODI与LL矫正度(ΔLL)、SS矫正度(ΔSS)、HOD矫正度(ΔHOD)、PI矫正度(ΔPI)不存在相关性(P>0.05),与ΔSL呈显著正相关(P<0.05),与ΔPT呈显著负相关(P<0.05)。结论PLIF可改善DLS患者的矢状位平衡和临床疗效,SL和PT的恢复与预后良好相关,充分矫正PT对降低术后FBSS的发生率有积极作用。Objective To explore the relationship between lumbosacral sagittal balance and failed back surgery syndrome(FBSS)after posterior interbody fusion(PLIF)in patients with degenerative lumbar spondylolisthesis(DLS).Methods DLS patients who received posterior interbody fusion in our hospital from January 2017 to August 2019 were selected as the research objects.Lumbar lordosis(LL),segmental lordosis(SL),sacral angle(SS),intervertebral disc height(hod),pelvic incidence angle(PI)and pelvic inclination angle(PT)were measured before and after operation,and visual analogue pain scale(VAS)and ODI index were evaluated.The correlation between the parameters of lumbosacral sagittal balance and FBSS was observed.Results VAS and ODI of postoperative patients were significantly lower than those before operation(P<0.05).The incidence of FBSS was 19.47%.The body mass index≥24kg/m^(2),symptom duration,lateral recess stenosis,anxiety,depression and operation time of patients with FBSS were higher than those of non FBSS(P<0.05).The postoperative SL,ΔSL,ΔVAS andΔODI in FBSS group were lower than those in non FBSS group(P<0.05),while Pt,ΔPt,VAS and ODI after operation were higher than those in non FBSS group(P<0.05).Binary logistic analysis showed that the symptom duration,lateral recess stenosis andΔPT were the risk factorsfor FBSS(P<0.05).ΔVAS andΔODI were not correlated withΔLL,ΔSS,ΔHOD andΔPI(P>0.05),but positively correlated withΔSL(P<0.05),and negatively correlated withΔPT(P<0.05).Conclusion PLIF can improve the sagittal balance and clinical efficacy of DLS patients.The recovery of SL and PT is related to the good prognosis.Full correction of PT has a positive effect on reducing postoperative FBSS.

关 键 词：腰椎滑脱 后路椎间融合术 矢状位平衡 腰椎手术失败综合征 

分 类 号：R687.3[医药卫生—骨科学]