中国组织工程研究 ›› 2022, Vol. 26 ›› Issue (33): 5370-5375.doi: 10.12307/2022.718

• 骨与关节图像与影像 bone and joint imaging • 上一篇    下一篇

退变性脊柱侧凸骨盆腰椎匹配值与疗效的相关性

潘希安1,梁思敏2,刘炳霞3,宋天增3,马  赫3,吴  鹏3,戈朝晖2   

  1. 1鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)骨科,湖北省黄石市   435000;2宁夏医科大学总医院骨科,宁夏回族自治区银川市   750004; 3宁夏医科大学临床医学院,宁夏回族自治区银川市   750004
  • 收稿日期:2018-05-02 接受日期:2018-06-30 出版日期:2022-11-28 发布日期:2022-03-31
  • 通讯作者: 戈朝晖,主任医师,教授,博士生导师,宁夏医科大学总医院骨科,宁夏回族自治区银川市 750004
  • 作者简介:潘希安,男,湖北省阳新县人,2018年宁夏医科大学毕业,硕士,主治医师,主要从事脊柱外科方面的研究。

Correlation between pelvic incidence-lumbar lordosis and clinical outcome in patients with degenerative lumbar scoliosis

Pan Xian1, Liang Simin2, Liu Bingxia3, Song Tianzeng3, Ma He3, Wu Peng3, Ge Zhaohui2   

  1. 1Department of Orthopedics, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi 435000, Hubei Province, China; 2Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China; 3Clinical Medical School of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • Received:2018-05-02 Accepted:2018-06-30 Online:2022-11-28 Published:2022-03-31
  • Contact: Ge Zhaohui, Chief physician, Professor, Doctoral supervisor, Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China
  • About author:Pan Xian, Master, Attending physician, Department of Orthopedics, Huangshi Central Hospital of Edong Healthcare Group, Hubei Polytechnic University, Huangshi 435000, Hubei Province, China

摘要:

文题释义:
退变性脊柱侧凸:指既往无侧凸病史,椎体发育成熟后由于不对称退变导致腰椎冠状面侧凸Cobb角> 10°的脊柱畸形,发病年龄通常在50岁以上,女性多发,发生病变的椎体常位于腰椎,故又称老年性侧凸或腰椎退变性侧凸。临床主要表现为腰椎侧凸畸形、顽固性的腰背痛、间歇性跛行、神经根性症状等,病情严重者生活质量差,站立及行走困难,对患者身心健康产生严重损害。 
骨盆腰椎匹配值:即为骨盆入射角与腰椎前凸角的差值,骨盆入射角与腰椎前凸角关系密切,反映了骨盆与腰椎的匹配情况,其与退变性脊柱侧凸患者的临床疗效密切相关,常用于术前矫正腰椎前凸的设计。

背景:退变性脊柱侧凸患者脊柱骨盆矢状位参数与临床疗效密切相关,SCHWAB教授曾提出腰椎前凸角=骨盆入射角±9° 的标准,但统计学显示国内人群骨盆入射角值较欧美人群小,应用此公式对国内患者进行腰椎前凸矫正存在争议。
目的:评估退变性脊柱侧凸患者脊柱后路椎弓根螺钉内固定术后骨盆腰椎匹配值与临床疗效的相关性,探索合适的腰椎骨盆匹配程度。
方法:回顾性分析于2015年1月至2017年8月在宁夏医科大学总医院行脊柱后路椎弓根螺钉内固定治疗的32例退变性脊柱侧凸患者的病历资料,随访时间均> 6个月。分别测量、计算出术前和术后末次随访时的侧凸Cobb角、腰椎前凸角、T1骨盆角、矢状位垂直轴、骨盆入射角、骨盆倾斜角、骶骨倾斜角、骨盆腰椎匹配值;记录患者术前和术后末次随访的目测类比评分、Oswestry功能障碍指数、SF-12健康生活质量调查问卷评分。
结果与结论:①术后末次随访患者脊柱侧凸Cobb角、T1骨盆角、骨盆倾斜角、骨盆腰椎匹配值、目测类比评分和生活功能障碍指数较术前显著减小(P < 0.05-0.001),腰椎前凸角、骶骨倾斜角、SF-12评分较术前显著增大(P < 0.05-0.001),矢状位垂直轴手术前后无明显变化(P > 0.05),术后末次随访时症状得到明显改善,疗效满意;②术后末次随访时骨盆腰椎匹配值与矢状位垂直轴、T1骨盆角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、目测类比评分、生活功能障碍指数和SF-12评分均具有相关性(r=0.387,0.433,0.660,0.575,0.313,0.400,0.378,-0.352,P < 0.05);③散点图及曲线拟合结果提示,术后末次随访时骨盆腰椎匹配值在-10°-7°区间内患者可获得较好的临床匹配(以术后目测类比评分< 3分、Oswestry功能障碍指数< 20%、SF-12评分> 130分为标准);④术后骨盆腰椎匹配值在-10°-7°区间内记为A组,不在-10°-7°区间记为B组,独立样本t 检验结果显示,A、B组患者术前目测类比评分、Oswestry功能障碍指数、SF-12评分相比差异无显著性意义(P均 > 0.05),术后A组目测类比评分、Oswestry功能障碍指数更低(P < 0.05,P < 0.01),SF-12评分更高(P < 0.01);⑤提示退变性脊柱侧凸患者脊柱后路椎弓根螺钉内固定术后骨盆腰椎匹配值与临床疗效密切相关,末次随访时骨盆腰椎匹配值在-10°-7°区间内的患者可获得较好的修复效果。
缩略语:退变性脊柱侧凸:degenerative lumbar scoliosis,DLS;Oswestry功能障碍指数:Oswestry disability index,ODI;健康生活质量调查问卷:Short-Form-12 Health survey,SF-12

https://orcid.org/0000-0002-8360-4904 (潘希安) 

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 退变性脊柱侧凸, 骨盆入射角, 腰椎前凸角, 骨盆腰椎匹配值, 影像学参数

Abstract: BACKGROUND: The sagittal parameters of the spine and pelvis in patients with degenerative scoliosis are closely related to the clinical efficacy. Professor SCHWAB once proposed the standard of lumbar lordosis = pelvic incidence angle ±9°, but statistics showed that the pelvic incidence angle of the domestic population was smaller than that of the European and American population. The application of this formula to the correction of lumbar lordosis in domestic patients is controversial.  
OBJECTIVE: To evaluate the correlation between pelvic incidence-lumbar lordosis and clinical outcomes after posterior spinal pedicle screw internal fixation for degenerative lumbar scoliosis, and explore the appropriate matching of lumbar vertebrae and pelvis.
METHODS:  A retrospective analysis of the medical records of 32 patients with degenerative scoliosis who underwent posterior pedicle screw fixation at the General Hospital of Ningxia Medical University from January 2015 to August 2017 was performed. The follow-up time was all > 6 months. Cobb angle, lumbar lordosis, T1 pelvic angle, sagittal vertical axis, pelvic incidence, pelvic til, sacral slope, and pelvic incidence-lumbar lordosis were measured and calculated preoperatively and at final follow-up. Visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score were recorded preoperatively and at final follow-up.  
RESULTS AND CONCLUSION: (1) Cobb angle, T1 pelvic angle, pelvic til, pelvic incidence-lumbar lordosis, Visual analogue scale score, and Oswestry disability index at final follow-up were significantly less than those before operation (P < 0.05-0.001). Lumbar lordosis, sacral slope, and Short-Form-12 Health survey score were significantly increased at final follow-up compared with those before operation (P < 0.05-0.001). Sagittal vertical axis was not significantly different before and after operation (P > 0.05). Symptoms were significantly relieved at the final follow-up postoperatively, and the efficacy was satisfied. (2) Pelvic incidence-lumbar lordosis was associated with sagittal vertical axis, T1 pelvic angle, pelvic incidence, pelvic til, sacral slope, visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score at the final follow-up (r=0.387, 0.433, 0.660, 0.575, 0.313, 0.400, 0.378, -0.352, P < 0.05). (3) The scatter diagrams and fitting curve results suggested that the patients could get a better clinical match when the pelvic incidence-lumbar lordosis of final follow-up was in the -10°-7° interval (postoperative visual analogue scale score < 3, Oswestry disability index < 20%, and Short-Form-12 Health survey score > 130 as standards). (4) Patients whose postoperative pelvic incidence-lumbar lordosis was in -10°-7° interval were as group A; those whose postoperative pelvic incidence-lumbar lordosis was not in -10°-7° interval were as group B. Independent sample t-test showed that there was no significant difference in the visual analogue scale score, Oswestry disability index, and Short-Form-12 Health survey score preoperatively in both groups A and B (all P > 0.05). Visual analogue scale score and Oswestry disability index were lower (P < 0.05, P < 0.01), but Short-Form-12 Health survey score was higher (P < 0.01) in group A postoperatively. (5) It is concluded that pelvic incidence-lumbar lordosis has a correlation with clinical outcomes. The patients whose pelvic incidence-lumbar lordosis was in the  -10°-7° interval can obtain better clinical outcome at the final follow-up.

Key words: degenerative scoliosis, pelvic incidence, lumbar lordosis, pelvic incidence-lumbar lordosis, imaging parameter

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