退行性腰椎侧凸术后冠状面平衡变异性与骨盆倾斜方向的相关性研究  

Correlation between postoperative coronal balance variability and orientation of pelvic obliquity in degenerative lumbar scoliosis

作　　者：蒋彬 王冰[1] 李亚伟[1] 李磊[1] 刘子群 谭人淳 艾斯卡尔·艾麦尔 陈家林 袁涛 罗李 郭灿 JIANG Bin;WANG Bing;LI Ya-wei;LI Lei;LIU Zi-qun;TAN Ren-chun;Aisimaier Aimer;CHEN Jia-lin;YUAN Tao;LUO Li;GUO Can(Department of Spine Surgery,The Second Xiangya Hospital of Central South University,Changsha,Hunan,410011,China)

机构地区：[1]中南大学湘雅二医院脊柱外科,湖南省410011

出　　处：《中国骨与关节杂志》2024年第7期484-490,共7页Chinese Journal of Bone and Joint

基　　金：湖南省重点研发计划(2021SK2002)。

摘　　要：目的探讨一期后路椎弓根螺钉固定矫形治疗退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)术后冠状面平衡变异性与骨盆倾斜(pelvic obliquity,PO)方向的相关性。方法回顾分析2014年1月至2021年1月于我院接受一期后路椎弓根螺钉固定矫形治疗的71例DLS患者,收集患者年龄、性别、固定节段数、近端固定椎(upper instrumented vertebral,UIV)、远端固定椎(lower instrumented vertebra,LIV)、截骨方式等一般临床资料及术前、术后、终末随访相关影像学参数:骨盆倾斜角(pelvic obliquity angle,POA),主弯Cobb’s角(main curve Cobb,MC Cobb),腰骶半弯(lumbosacral fractional curve,LFC),L_(4)倾斜角(L_(4)tilt),L_(5)tilt,躯干倾斜(trunk shift,TS)即C7铅垂线(C7plumb line,C7PL)至骶骨中垂线(center sacral vertical line,CSVL)的水平距离。PO低髂嵴侧定义为PO方向。C7PL位于PO低髂嵴侧时定义为TS/PO方向一致,TS为正值,C7PL位于PO高髂嵴侧时定义为TS/PO方向不一致,TS为负值。根据矫形术后患者TS绝对值<3 cm或≥3 cm分为冠状面平衡组(coronal balance group,CB group)和冠状面失衡组(coronal imbalance group,CIB group),比较两组患者一般临床资料及上述影像学参数。再根据终末-术后冠状面平衡变异性分为3组,A组:C7PL朝向S_(1)中心位移>1 cm;B组:C7PL位移绝对值≤1 cm;C组:C7PL偏离S_(1)中心位移>1 cm。比较术后至终末随访的影像学参数,采用相关性分析影响术后随访过程中冠状面平衡变异性的可能因素。结果71例DLS患者经一期后路椎弓根螺钉固定矫形术后,MC Cobb矫正率(70.5±14.2)%;LFC矫正率(64.9±20.7)%;术前CIB发生率由23.9%增至35.2%。术后平衡组与失衡组患者术前性别、年龄、融合节段数、随访时间、UIV及LIV选择、是否截骨差异均无统计学意义(P>0.05)。两组患者术前LFC、术后L_(4)tilt、术后POA,术前、术后TS/PO方向一致性差异均有统计学意义(P<0.05)。术前及术后MC Cobb、术前L_(4)tilObjective To investigate the correlation between postoperative coronal balance and variability of pelvic obliquity(PO)after one-stage posterior pedicle screw fusion surgery for degenerative lumbar scoliosis(DLS).Methods A retrospective analysis of 71 patients with DLS treated with single-stage posterior pedicle screw fixation in our hospital from January 2014 to January 2021 was conducted.Demographic data such as patient age,gender,fusion segments,upper instrumented vertebral(UIV),lower instrumented vertebra(LIV),osteotomy modality and a series of preoperative,postoperative and final follow-up radiographic parameters were collected as follows:pelvic obliquity angle(POA),main curve cobb(MC cobb),lumbosacral fractional curve(LFC),L(4) tilt,L_(5) tilt,Trunk shift(TS),cervical 7 plumb line(C7PL),centre sacral vertical line(CSVL),thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT).The lower side of the bilateral iliac spine was identified as the PO direction.Relative position of TS and PO:TS/PO was defined as TS/PO ipsilateral when C7PL was on the low iliac spine side of PO,and TS/PO opposite when C7PL was on the high iliac spine side of PO.Patients were divided into coronal balance group(CB group)and coronal imbalance group(CIB group)according to TS≤3 cm or TS>3 cm after surgery.Demographic data and the radiographic parameters above were compared between the two groups,and the risk factors for postoperative CIB were investigated.Paired samples t-test was used for within-group before-after comparisons,independent samples t-test for between-group comparisons of continuous variables,and U-test when data were non-normal or variance was not homogeneous.Chi-squared test was used for dichotomous variables,and Fisher’s exact test was used when the frequency was less than 5.Three groups were classified according to the C7PL variation from postoperative to final follow-up.Group A:C7PL close to the centre of S_(1)>1 cm,Group B:C7PL variation<1 cm and Gr

关 键 词：脊柱侧凸 腰椎 矫形外科手术 

分 类 号：R682.3[医药卫生—骨科学]