退变性腰椎侧凸短节段固定融合术后冠状面失衡的危险因素分析  

Risk factors of coronal imbalance following posterior lumbar short-level fixation and fusion for degenerative lumbar scoliosis

作　　者：卢政中 吴晓东 彭驰 李星宇 徐增 顾一飞 王辉 王建喜 臧法智 胡博 郑根江 杨晨 金志超 周许辉 袁文 陈华江 Lu Zhengzhong;Wu Xiaodong;Peng Chi;Li Xingyu;Xu Zeng;Gu Yifei;Wang Hui;Wang Jianxi;Zang Fazhi;Hu Bo;Zheng Genjiang;Yang Chen;Jin Zhichao;Zhou Xuhui;Yuan Wen;Chen Huajiang(Department of Orthopedics,Shanghai Changzheng Hospital,Naval Medical University,Shanghai 200003,China;Department of Emergency,Shanghai Changhai Hospital,Naval Medical University,Shanghai 200433,China;Graduate School,Naval Medical University,Shanghai 200433,China;People′s Liberation Army 66069th Hospital,Henan 471023,China;Department of Health Statistics,Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长征医院脊柱外科,上海200003 [2]海军军医大学附属长海医院急诊科,上海200433 [3]海军军医大学研究生院,上海200433 [4]中国人民解放军第66069部队医院,河南471023 [5]海军军医大学军队卫生统计学教研室,上海200433

出　　处：《中华医学杂志》2025年第9期673-680,共8页National Medical Journal of China

基　　金：国家自然科学基金(82072485);上海市自然科学基金(21Y11911300)。

摘　　要：目的探讨退变性腰椎侧凸(DLS)患者行短节段固定融合术后发生冠状面失衡的危险因素。方法回顾性分析2018年1月至2022年12月于上海长征医院行短节段固定融合手术的DLS患者的临床资料。术后随访时间12个月,根据术后C_(7)铅垂线与骶骨中垂线(CSVL)的距离(C_(7)-CSVL)≥20 mm和<20 mm,将患者分为失衡组和平衡组,比较两组患者的人口学、术前影像学和手术因素的差异。分别将同侧型和对侧型DLS患者的胸腰椎主弯大小、C_(7)-CSVL偏移大小、顶椎偏移大小和腰骶椎基底弯大小通过受试者工作特征(ROC)曲线明确导致术后冠状面失衡的截断值。采用logistic回归模型分析DLS患者行短节段固定融合术后发生冠状面失衡的危险因素。结果共纳入234例行短节段固定融合术的DLS患者,其中,男62例,女172例,年龄(66.90±6.93)岁。其中,44例患者为失衡组,男12例,女32例,年龄(68.50±7.06)岁,190例为平衡组,男50例,女140例,年龄(66.54±6.86)岁。术后平衡组术前C_(7)-CSVL[(1.63±1.36)cm比(2.51±1.66)cm]、下固定椎倾斜角(4.84°±4.65°比6.81°±4.94°)、下固定椎旋转度Nash-moe分级1度[32例(16.84%)比12例(28.57%)]、胸腰椎主弯角(19.15°±6.85°比26.74°±8.02°)、腰椎基底弯角(9.64°±5.27°比13.83°±5.01°)、顶椎偏移距离[(1.95±0.92)cm比(3.11±0.96)cm和主弯僵硬度僵硬型[62例(32.6%)比24例(54.5%)]均低于失衡组(均P<0.05)。将ROC曲线截断值的分类变量(胸腰椎主弯类型、C_(7)-CSVL偏移类型、顶椎偏移类型、腰骶椎基底弯类型)以及启动弯的矫正类型等两组比较差异所有P值<0.05的变量纳入多因素logistic回归分析,结果显示,胸腰椎主弯类型为高角度型(OR=11.98,95%CI:3.680~39.000)、C_(7)-CSVL偏移类型为高偏移型(OR=6.603,95%CI:2.324~18.759)、顶椎偏移类型为高偏移型(OR=4.362,95%CI:1.498~12.700)、腰骶椎基底弯类型为高角度型(OR=3.756,95%CI:1.191~11.847)及启动弯矫正类型为�Objective To explore the risk factors associated with coronal imbalance following posterior short-level fixation and fusion surgery for patients with degenerative lumbar scoliosis(DLS).Methods A retrospective analysis was conducted on the clinical data of patients who underwent posterior short-level fixation and fusion for the treatment of DLS at Shanghai Changzheng Hospital from January 2018 to December 2022.The postoperative follow-up period was 12 months.Based on the postoperative distance between the C_(7)plumb line and the central sacral vertical line(C_(7)-CSVL),patients were divided into an imbalance group(C_(7)-CSVL≥20 mm)and a balance group(C_(7)-CSVL<20 mm).Demographics,radiographic and surgical factors were compared between the two groups.The cutoff values for postoperative coronal imbalance in patients with ipsilateral and contralateral DLS were determined by analyzing the main curve sizes of the thoracolumbar spine,C_(7)-CSVL offset,apex vertebra offset,and lumbosacral base curve size using receiver operating characteristic(ROC)curves.A logistic regression model was performed to detect the risk factors for postoperative coronal imbalance following short-level fixation and fusion in patients with DLS.Results A total of 234 patients[62 males,172 females,with a mean age of(66.90±6.93)years]who underwent short-level fixation and fusion surgery for DLS were included in this study.Of these,44 patients progressed postoperative coronal imbalance[12 males,32 females,with an average age of(68.50±7.06)years],190 patients did not endure postoperative coronal imbalance[50 males,140 females,with a mean age of(66.54±6.86)years].There were differences between the coronal balance group and the coronal imbalance group in preoperative C_(7)-CSVL[(1.63±1.36)cm vs(2.51±1.66)cm],lowest instrumented vertebra(LIV)tilt(4.84°±4.65°vs 6.81°±4.94°),LIV rotation[Nash-moe grade one,32 cases(16.84%)vs 12 cases(28.57%)],Cobb-angle of the thoracolumbar main curve(19.15°±6.85°vs 26.74°±8.02°),Cobb-angle of the frac

关 键 词：脊柱侧凸 退变性腰椎侧凸 短节段融合固定术 术后冠状面失衡 危险因素 

分 类 号：R68[医药卫生—骨科学]