退行性腰椎侧凸冠状面失衡新分型及优先-匹配矫正方法  

New classification of global coronal malalignment in degenerative lumbar scoliosis and priority-matching correction technique

作　　者：朱卫国 鲁世保[1] 王宇 陈小龙 孔超 王玮[1] 李翔宇 ZHU Wei-guo;LU Shi-bao;WANG Yu;CHEN Xiao-long;KONG Chao;WANG Wei;LI Xiang-yu(Department of Orthopedics,Xuanwu Hospital,Capital Medical University,Beijing,100032,China)

机构地区：[1]北京首都医科大学宣武医院骨科,北京100032

出　　处：《中国骨与关节杂志》2024年第7期491-497,共7页Chinese Journal of Bone and Joint

基　　金：首都医科大学培育项目(PYZ22047);首都医科大学宣武医院英才种子计划(YC20220104)。

摘　　要：目的介绍退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者脊柱整体冠状面形态异常(global coronal malalignment,GCM)的新分型并分析基于此分型的优先-匹配矫正技术减少术后冠状面失衡发生的有效性。方法回顾分析2020年1月至2023年10月在我科接受手术治疗和非手术治疗的382例DLS患者的GCM,其中男52例,女330例;平均年龄(65.3±2.4)岁。将GCM分为1型和2型,以腰弯为核心弯的GCM为1型,以腰骶弯为核心弯的GCM为2型。其中对冠状面躯干偏移贡献更大的弯被定义为核心弯,优先-匹配矫形理念的基本原则即优先并充分矫正核心弯。手术患者接受优先-匹配矫正手术或传统矫正手术。分析新分型的可靠性,比较不同分型和分组间患者的临床和影像学参数。结果可信度分析结果显示新分型具有较好的组内和组间可重复性[组内相关系数(intradass correlation coefficient,ICC)>0.75]。1型患者占42.4%,2型患者占57.6%。相比于1型患者,2型患者具有较大的腰骶弯Cobb’s角[(17.9±3.4)°vs.(7.5±3.0)°,P<0.001]和L_(4)tilt[(18.7±4.2)°vs.(11.6±4.4)°,P<0.001]。118例患者接受矫形手术治疗,其中55例接受优先-匹配矫正技术,63例接受传统矫正技术。30例患者在平均随访(15.0±2.1)个月后出现冠状面失衡,16.7%为1型GCM,83.3%为2型GCM。接受优先-匹配矫正和传统矫正患者术后冠状面失衡的发生率分别为7.3%和41.3%(P<0.001)。结论DLS患者GCM新分型基于侧弯对G_(7)铅垂线(G_(7)plumb,C7PL)偏移的贡献距离。以腰弯为核心弯的GCM为1型,以腰骶弯为核心弯的GCM为2型。基于新分型的优先-匹配矫正技术被证实能够显著减少DLS矫形术后冠状面失代偿的发生。Objective To introduce a new classification of global coronal malalignment(GCM)in degenerative lumbar scoliosis(DLS)and to investigate the effect of priority-matching correction technique on preventing the postoperative coronal decompensation.Methods A retrospective analysis of 382 patients with GCM who underwent correction surgery or not at our center from 2020 was performed.They were 330 females and 52 males,with an average age of(65.3±2.4)years.Two types of GCM pattern were identified.GCMs with lumbar curve as the key curve were classified as Type 1 GCM and those with lumbosacral curve as the key curve were classified as Type 2GCM.The curve with the greatest contribution to C7PL shifting was determined as the key curve.The fundamental principle of priority-matching correction was to first and aggressively correct the key curve.Patients were assigned to the priority-matching correction surgery or the traditional correction surgery.The reliability of this new classification was analyzed and the clinical and radiographic outcomes were compared between different subgroups.Results Intraclass correlation coefficient(ICC)analysis indicated that this new classification had adequate intra-and inter-rater reliabilities(ICC>0.75).Type 1 GCM occupied 42.4%and Type 2 GCM occupied 57.6%.Compared with Type 1 GCM,Type 2 GCM had greater LS Cobb’s angle[(17.9±3.4)°vs.(7.5±3.0)°,P<0.001]and L_(4)tilt angle[(18.7±4.2)°vs.(11.6±4.4)°,P<0.001].One hundred and eighteen patients received correction surgeries,thereinto 55 patients underwent priority-matching correction and 63 underwent traditional correction.Thirty patients were found to develop coronal imbalance after mean follow-up of(15.0±2.1)months,16.7%of them had Type 1 GCMs and 83.3%had Type 2 GCMs.The incidences of postoperative coronal decompensation were respectively 7.3%and 41.3%in patients who received priority-matching correction and in patients undergoing traditional correction(P<0.001).Conclusions This new classification for GCM in DLS is designed based on t

关 键 词：脊柱疾病 腰椎 脊柱侧凸 优先-匹配矫正 

分 类 号：R682.3[医药卫生—骨科学]