腰椎过度前凸对重度神经肌源性脊柱侧凸的矫形疗效的影响  

Impact of hyperlordosis on orthopedic correction outcomes in severe neuromuscular scoliosis

作　　者：李奉芮 李劼 凌宸 刘臻[2] 邱勇[2] 朱泽章 Li Fengrui;Li Jie;Ling Chen;Liu Zhen;Qiu Yong;Zhu Zezhang(Department of Orthopedic Spine Surgery,Gulou School of Clinical Medicine,Nanjing University of Chinese Medicine,Nanjing 210008,China;Department of Orthopedic Spine Surgery,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院骨科脊柱外科,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《中华医学杂志》2025年第15期1164-1171,共8页National Medical Journal of China

基　　金：江苏省医学创新中心(CXZX202214)。

摘　　要：目的比较伴或不伴过度腰椎前凸的神经肌源性脊柱侧凸(NMS)患者的脊柱矫形手术疗效,分析过度腰椎前凸对疗效的影响。方法回顾性分析2008年4月至2022年6月于南京鼓楼医院接受手术治疗的102例重度NMS患者的病例资料,男34例,女68例;年龄[M(Q_(1),Q_(3))]为18(12,26)岁。脑瘫25例,脊髓脊膜膨出7例,肌病28例,创伤后截瘫12例,小儿麻痹症30例。按照患者术前腰椎前凸程度的不同将患者分为2组:腰椎前凸<70°患者62例(非前凸组),腰椎前凸≥70°患者40例(前凸组)。记录比较2组患者术前、术后及末次随访时侧凸Cobb角、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、骨盆倾斜角(PO)、矢状面平衡(SVA),并比较2组术后及随访期间的并发症发生情况。在术前及末次随访时采用脊柱侧凸研究协会问卷(SRS⁃22)评估2组患者疗效。结果前凸组与非前凸组患者的年龄、性别差异均无统计学意义(均P>0.05)。前凸组术前Cobb角与LL均大于非前凸组(均P<0.001)。前凸组手术时间为(374±59)min,长于非前凸组的(295±42)min(P<0.001);两组出血量为(2018±978)ml和(1603±805)ml(P=0.028)。术后两组患者冠状面和矢状面都获得矫正,两组患者末次随访与术后即刻相比冠状面Cobb角和矢状面LL差异均有统计学意义(均P<0.05)。前凸组7例置钉不良,1例术后出现血肿,2例出现切口深部感染,1例出现术中大出血。非前凸组4例置钉不良,2例硬脊膜撕裂,2例并发术后近端交界性后凸。前凸组与非前凸组并发症发生率分别为32.50%(13/40)和9.68%(6/62)(P=0.004)。前凸组术前生活质量SRS⁃22总分低于非前凸组[分别为(1.84±0.25)分和(2.65±0.26)分](P<0.001),术后均有提高[分别为(3.54±0.20)分和(3.45±0.45)分],术后两组差异无统计学意义(P=0.287)。结论与不伴有腰椎过度前凸患者相比,伴过度前凸的NMS患者矫形手术治疗矫形难度Objective To evaluate and compare surgical outcomes of orthopedic correction in neuromuscular scoliosis(NMS)patients with or without excessive lumbar lordosis,and to analyze the impact of excessive lumbar lordosis on treatment efficacy.Methods The case data of 102 patients with severe NMS were retrospectively analyzed,there were 34 males and 68 females.The patients underwent surgical treatment at Nanjing Gulou Hospital from April 2008 to June 2022;the age M(Q_(1),Q_(3))was 18(12,26)years.There were 25 cases of cerebral palsy,7 cases of spinal cord bulge,28 cases of myopathy,12 cases of post-traumatic paraplegia,and 30 cases of poliomyelitis.The patients were divided into 2 groups according to the degree of preoperative lumbar lordosis:62 patients with lumbar lordosis<70°(non-hyperlordotic group)and 40 patients with lumbar lordosis≥70°(hyperlordotic group).Radiographic parameters were evaluated preoperatively,postoperatively,and at final follow-up,including scoliosis Cobb angle,thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),pelvic obliquity(PO),and SVA.Postoperative complications and follow-up outcomes were compared between groups.The Scoliosis Research Society-22(SRS-22)questionnaire was administered preoperatively and at final follow-up to assess clinical outcomes in both groups.Results No statistically significant differences were observed in age and gender distribution between the hyperlordotic and non-hyperlordotic groups(all P>0.05).The hyperlordotic group demonstrated greater preoperative Cobb angles and lumbar lordosis compared to the non-hyperlordotic group(all P<0.01).Operative time was significantly longer in the hyperlordotic group(374±59)min compared to the non-hyperlordotic group(295±42)min(P<0.001),with intraoperative blood loss of(2018±978)ml and(1603±805)ml,respectively(P=0.028).Significant postoperative correction was obtained in both coronal and sagittal planes in both groups,and there was a significant difference in coronal Cobb angle and

关 键 词：脊柱侧凸 神经肌源性侧凸 腰椎前凸 疗效比较研究 

分 类 号：R687.3[医药卫生—骨科学]