中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (12): 1956-1961.doi: 10.12307/2024.015

• 骨与关节综述 bone and joint review • 上一篇    下一篇

退变性腰椎滑脱行减压融合可影响脊柱矢状面的失衡

史浩冉,关海山,王悦勇,刘  涛   

  1. Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • 收稿日期:2023-02-20 接受日期:2023-03-24 出版日期:2024-04-28 发布日期:2023-08-23
  • 通讯作者: 关海山,主任医师,山西医科大学第二医院骨科,山西省太原市 030001
  • 作者简介:史浩冉,男,1996年生,汉族,山西省晋城市人,山西医科大学在读硕士,主要从事脊柱外科方面研究
  • 基金资助:


Decompression and fusion for degenerative lumbar spondylolisthesis affect sagittal disequilibrium of the spine

Shi Haoran, Guan Haishan, Wang Yueyong, Liu Tao   

  1. 山西医科大学第二医院骨科,山西省太原市   030001
  • Received:2023-02-20 Accepted:2023-03-24 Online:2024-04-28 Published:2023-08-23
  • Contact: Guan Haishan, Chief physician, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
  • About author:Shi Haoran, Master candidate, Department of Orthopedics, Second Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China

摘要:


文题释义:

退变性腰椎滑脱:腰椎退变性滑脱又称假性滑脱,是成人滑脱最常见的类型,是由于腰椎间盘退变和关节突关节骨关节炎所导致的腰椎位移。
矢状面平衡:脊柱矢状面平衡是机体以最小能耗维持脊柱整体、局部生理曲度和力线结构的状态,矢状面平衡可以减轻背部肌肉的压力及负荷,并改善腰椎手术的效果。退变、炎症、创伤、感染、肿瘤、先天或医源性因素等导致椎体序列以及力线的改变引起的脊柱矢状面失衡是患者发生脊柱疼痛和活动受限的主要原因。


背景:腰椎减压融合是治疗腰椎退行性滑脱最有效的手术方式。近几年来脊柱矢状面平衡被广泛认为是调节脊柱手术患者结局的关键因素,能够影响脊柱矢状面平衡的因素间接影响手术疗效和预后。

目的:归纳并总结因退变性腰椎滑脱行减压融合术时可以影响脊柱矢状面平衡相关危险因素,对腰椎滑脱的手术治疗起到一定参考作用。
方法:以“腰椎滑脱,脊柱矢状面平衡,手术治疗,危险因素”为中文检索词,以“lumbar spondylolisthesis,sagittal balance,risk factor”为英文检索词,分别检索PubMed、Springer、ScienceDirect、万方、维普及中国知网数据库。检索时间范围主要为2010年1月至2023年1月,同时纳入少数经典远期文献。通过阅读文题和摘要进行初步筛选;排除中英文文献重复性研究、低质量期刊及内容不相关的文献,最后纳入67篇文献进行综述。

结果与结论:①退行性腰椎滑脱是造成椎管狭窄和腰椎不稳的一个重要因素,也是产生下腰痛和间歇性跛行的主要病因。腰椎减压融合内固定是治疗退行性腰椎滑脱切实有效的方法。②以往的减压融合固定治疗退行性腰椎滑脱重点在于彻底神经根探查松解、滑脱椎体复位以及牢靠的内固定,而对于脊柱矢状面平衡关注较少。③随着腰椎减压融合内固定术的普及,因脊柱矢状面失衡造成的并发症逐渐增多,从而导致患者预后差,甚至二次手术风险增加。④以往的研究仅讨论腰椎矢状面参数与脊柱矢状面平衡的相关性,未深入研究造成脊柱矢状面失衡的相关因素。⑤文章结果表明,开放式腰椎固定融合、滑脱椎体完全复位、选用较粗的椎弓根螺钉、选用较大型号融合器以及自体骨移植是维持矢状面平衡的有利因素,而融合节段数越多、融合节段平面越高,是影响矢状面失衡的危险因素。

https://orcid.org/0000-0005-2951-9302 (史浩冉) 

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

Abstract: BACKGROUND: Lumbar decompression and fusion is the most effective surgical method to treat lumbar degenerative spondylolisthesis. In recent years, the sagittal balance of the spine has been widely considered the key factor to adjust the outcome of spinal surgery, and factors that can affect the sagittal balance of the spine indirectly affect the surgical effect and prognosis. 
OBJECTIVE: To summarize the risk factors that can affect the sagittal balance of the spine during decompression and fusion due to lumbar spondylolisthesis, and play a certain reference role in the surgical treatment of lumbar spondylolisthesis.
METHODS: With “lumbar spondylolisthesis, the sagittal plane balance of the spine, surgical treatment, risk factors” as the Chinese search terms, and “lumbar spondylolisthesis, sagittal balance, risk factor” as the English search terms, PubMed, Springer, ScienceDirect, Wanfang, VIP and CNKI were searched respectively. The focus of the search was from January 2010 to January 2023, and a few classic long-term articles were included. Preliminary screening was conducted by reading the title and abstract. After excluding repetitive research in Chinese and English literature, low-quality journals and irrelevant literature, 67 articles were finally included for review.
RESULTS AND CONCLUSION: (1) Degenerative lumbar spondylolisthesis is an important factor causing spinal canal stenosis and lumbar instability, and is the main cause of low back pain and intermittent claudication. Lumbar decompression, fusion and internal fixation is an effective way to treat degenerative lumbar spondylolisthesis. (2) In the past, the treatment of degenerative lumbar spondylolisthesis with decompression, fusion and fixation focused on thorough exploration and release of nerve roots, reduction of spondylolisthesis and solid internal fixation, but less attention was paid to the balance of sagittal plane of the spine. (3) With the popularization of lumbar decompression, fusion and internal fixation, complications caused by the sagittal imbalance of the spine gradually increased, resulting in poor prognosis of patients and even increased risk of secondary surgery. (4) Previous studies have only discussed the correlation between lumbar sagittal plane parameters and spinal sagittal plane balance, but have not in-depth studied the relevant factors causing spinal sagittal plane imbalance. (5) Our results show that open lumbar fixation and fusion, complete reduction of spondylolisthesis, selection of thicker pedicle screws, selection of larger fusion cages, and autologous bone transplantation are beneficial factors for maintaining sagittal balance. The higher the number of fusion segments, the higher the level of fusion segments is, which is a risk factor for sagittal plane imbalance.

Key words: lumbar spondylolisthesis, sagittal plane balance, spine-pelvis sagittal imbalance, adjacent segment degeneration, fusion fixation, spine, internal fixation

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