脊柱-骨盆矢状面参数与两节段后路腰椎间融合术后疗效分析  

Spine-pelvic sagittal plane parameters and postoperative efficacy of two-segment posterior lumbar interbody fusion

作　　者：杜谢琴 王凤涛 冯晨 李静 夏杨 DU Xie-qin;WANG Feng-tao;FENG Chen;LI Jing;XIA Yang(Surgery Department,Wuhan Third Hospital,Wuhan,Hubei 430060,China;Orthopedics Department,Wuhan Third Hospital,Wuhan,Hubei 430060,China)

机构地区：[1]武汉市第三医院外科,湖北武汉430060 [2]武汉市第三医院骨科,湖北武汉430060

出　　处：《颈腰痛杂志》2024年第2期210-214,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：湖北省卫生健康委科研项目(编号:WJ2019M004)。

摘　　要：目的探讨脊柱-骨盆矢状面参数与两节段退行性腰椎滑脱症(lumbar degenerative spondylolisthesis,LDS)行后路腰椎间融合术后疗效的关系。方法选择2013年1月~2018年12月在该院接受两节段PLIF治疗的74例LDS患者作为研究对象,根据日本骨科协会(Japanese Orthopaedic Association,JOA)评分恢复率判定临床恢复效果,≥50%定义为疗效良好,反之则为疗效欠佳,将患者分为良好组和不良组。比较两组患者的矢状面平衡参数(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(PT,pelvic tilt)、骨盆入射角(pelvic incidence,PI)、腰椎前凸角(lumbar lordosis,LL)和节段性前凸角(segmental lordosis,SL),观察两组患者SL变化率(ΔSL)和LL变化率(ΔLL)。结果74例患者发生术中并发症2例(2.70%),发生术后并发症10例(13.51%)。末次随访时,所有患者JOA评分和SVA均显著高于术前(P<0.05);所有患者TK、LL、SL、SS、PT、PI、PI-LL与术前相比,差异均无统计学意义(P>0.05)。两组患者性别、年龄、随访时间、术前JOA评分相比,差异均无统计学意义(P>0.05);疗效良好组患者术后JOA评分和JOA恢复率均高于疗效不良组,差异有统计学意义(P<0.05)。两组患者术前、末次随访时SVA、TK、LL、SL、SS、PT、PI和PI-LL等参数组间相比,差异均无统计学意义(P>0.05)。疗效良好组ΔLL和ΔSL均高于疗效不良组(P<0.05)。ΔLL与ΔSL呈正相关(r=0.702,P<0.001)。结论两节段PLIF治疗L 3-4、L 4-5双节段LDS的临床效果满意,ΔSL与临床预后相关,ΔSL和ΔLL之间呈正相关。Objective To investigate the relationship between spine-pelvic sagittal plane parameters and postoperative efficacy of two-level posterior lumbar interbody fusion in patients with lumbar degenerative spondylolisthesis(LDS).Methods From January 2013 to December 2018,74 patients with LDS who received 2-level PLIF treatment in our hospital were selected as the research objects.According to the recovery rate of Japanese Orthopaedic Association(JOA)score,the patients were divided into the good curative effect group and the poor curative effect group.The sagittal vertical axis(SVA),thoracic kyphosis(TK),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),LL and SL of the two groups were compared.The change rates of SL(ΔSL)and LL(ΔLL)of the two groups were observed.Results In 74 patients,2 cases(2.70%)had intraoperative complications,and 10 cases(13.51%)had postoperative complications.JOA and SVA of all patients in the last follow-up were significantly higher than those before operation,and the difference was statistically significant(P<0.05).TK,LL,SL,SS,PT,PI,PI-LL of all patients in the last follow-up had no significant difference compared with those before operation(P>0.05).There were no significant differences in gender,age,follow-up time and preoperative JOA score between the two groups(P>0.05).The postoperative JOA score and JOA recovery rate in the good curative group were higher than those in the poor curative group(P<0.05).There were no significant differences in SVA,TK,LL,SL,SS,PT,PI and PI-LL between the two groups before operation and at the last follow-up(P>0.05).The changes of LL(ΔLL)and SL(ΔSL)in the good group were higher than those in the poor group(P<0.05).ΔLL was positively correlated with ΔSL(r=0.702,P<0.001).Conclusion The clinical effect of two-stage PLIF in treatment of L 3-4 and L 4-5 double segment LDS is satisfactory.ΔSL is related to clinical prognosis,andΔSL andΔll are positively correlated.

关 键 词：腰椎滑脱 腰椎退行性疾病 后路腰椎融合术 节段性前凸 

分 类 号：R687.3[医药卫生—骨科学]