术前脊柱矢状位失衡对侧路腰椎椎体间融合术后症状改善的影响  

Effect of preoperative sagittal spinal imbalance on symptom improvement after lumbar lateral fusion

作　　者：孟胜东 丁明胜[1] 解学关[1] 戴琰琨[1] 杨德坤 MENG Sheng-dong;DING Ming-sheng;JIE Xue-guan;DAI Yan-kun;YANG De-kun(Orthopedics Department of the Second People′s Hospital of Huai′an City,Jiangsu Province 223000,China;The Fifth People′s Hospital of Huai′an City,Jiangsu Province 223000,China)

机构地区：[1]江苏省淮安市第二人民医院骨科,江苏淮安223000 [2]扬州大学附属淮安医院(淮安市第五人民医院),江苏淮安223000

出　　处：《颈腰痛杂志》2024年第3期427-430,435,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的 探讨术前脊柱矢状位失衡对侧路腰椎椎体间融合术(LLIF)术后症状改善的影响。方法 选择2018年1月至2020年12月在该院接受LLIF的86例患者资料进行回顾性分析,根据术前矢状面轴向距离(sagittal vertical axis, SVA)将患者分为A组(SVA≥50 mm)和B组(SVA<50 mm)。观察两组患者临床资料、放射学参数[T2~S1的冠状位Cobb角、SVA、腰椎前凸角(LL)、T5~T12的胸椎后凸角(TK)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)和PI-LL]和临床症状改善情况。结果 术前,A组SVA、冠状位Cobb角(CR Cobb角)、PI-LL高于B组,LL低于B组,差异均有统计学意义(P<0.05);两组患者TK、PI、PT、SS差异均无统计学意义(P>0.05)。A组患者术后1年SVA和PI-LL高于B组,LL低于B组,差异均有统计学意义(P<0.05);A组患者ΔSVA、ΔLL、ΔPI-LL(Δ表示术后1年与术前的变化值)均高于B组,差异均有统计学意义(P<0.05)。术后1年两组患者腰痛、腿痛、腿麻木VAS评分均较术前显著降低(P<0.05),两组患者术后1年时的TK、PI、PT、SS及ΔTK、ΔPI、ΔPT和ΔSS差异均无统计学意义(P>0.05)。结论 LLIF手术对患者SVA的恢复效果有限,但可改善患者的临床症状。Objective To investigate the effect of preoperative sagittal spinal imbalance on postoperative symptom improvement after lateral lumbar interbody fusion(LLIF).Methods The data of 86 patients with LLIF in our hospital from January 2018 to December 2020 were retrospectively analyzed.The patients were divided into group A(high SVA Group)and group B(low SVA Group)according to SVA by SPSS hierarchical cluster analysis program.The clinical data,radiological parameters[coronal Cobb angle of T 2-S 1,sagittal axial distance(SVA),lumbar lordosis(LL),thoracic kyphosis(TK)of T 5-12,pelvic incidence angle(PI),pelvic tilt angle(PT),sacral inclination angle(SS)and PI-LL]and the improvement of clinical symptoms were observed.Results SVA,CR Cobb angle and PI-LL in group A were higher than those in group B,while LL was lower than that in group B(P<0.05).There was no significant difference in TK,PI,Pt and SS between the two groups(P>0.05).One year after operation,SVA and PI-LL in group A were higher than those in group B,and LL was lower than that in group B(P<0.05),and there were significant differences inΔSVA,ΔLL andΔPI-LL between the two groups(P<0.05).One year after operation,the VAS scores of low back pain,leg pain and leg numbness in the two groups were significantly lower than those before operation(P<0.05).There was no significant difference in TK,PI,Pt,SS,ΔTK,ΔPI,ΔPT andΔSS between the two groups one year after operation(P>0.05).Conclusion LLIF surgery has limited effect on the recovery of SVA,but it can improve the clinical symptoms of patients.

关 键 词：退行性腰椎疾病 侧路腰椎椎间融合术 矢状位平衡 临床症状 

分 类 号：R687.3[医药卫生—骨科学]