中国组织工程研究

中国组织工程研究 ›› 2024, Vol. 28 ›› Issue (24): 3778-3782.doi: 10.12307/2024.618

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

腰椎融合后矢状位力线与临床症状改善的相关性

方  钊，乔  攀，徐天同   

  1. 天津市人民医院脊柱外科，天津市   300121
  • 收稿日期:2023-06-19 接受日期:2023-08-04 出版日期:2024-08-28 发布日期:2023-11-20
  • 通讯作者: 徐天同，硕士，主任医师，天津市人民医院脊柱外科，天津市 300121
  • 作者简介:方钊，男，1985年生，天津市人，满族，南开大学毕业，硕士，主治医师，主要从事脊柱退行性病变研究。
  • 基金资助:
    天津市医学重点学科(专科)建设项目(TJYXZDXK-064B)，项目参与人：徐天同

Correlation between sagittal alignment and clinical symptom improvement after lumbar fusion

Fang Zhao, Qiao Pan, Xu Tiantong   

  1. Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
  • Received:2023-06-19 Accepted:2023-08-04 Online:2024-08-28 Published:2023-11-20
  • Contact: Xu Tiantong, Master, Chief physician, Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
  • About author:Fang Zhao, Master, Attending physician, Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
  • Supported by:
    Construction Project of Key Medical Disciplines (Specialties) in Tianjin, No. TJYXZDXK-064B (to XTT)

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摘要：


文题释义：

矢状位平衡：人体正常站立时，身体处于一个相对平衡状态，各个部位力学协调以维持脊柱矢状面位置，维持直立状态时耗能最少。此时，腰背部肌肉和韧带的力量使腰椎维持着合理的前凸，以最省力的模式完成日常生活的各项活动。
骨盆投射角与腰椎前凸角的差值：一个综合了脊柱和骨盆力线的参数，强调腰椎前凸角度与骨盆入射角度的匹配程度，该参数可以更直接地衡量脊柱骨盆的矢状位力线情况。


背景：目前关于腰椎管狭窄融合术后患者腰椎前凸角度及骨盆入射角度的匹配程度与术后临床症状改善相关性的研究报道较少。

目的：研究腰椎管狭窄融合术后患者腰椎前凸角度与骨盆入射角度的匹配程度(PI-LL)，分组比较不同匹配程度间脊柱骨盆矢状参数和临床结果的差异。
方法：回顾性分析2019年12月至2021年12月在天津市人民医院脊柱外科采用腰椎后路椎板减压融合内固定治疗的110例腰椎管狭窄患者的病历资料，男48例，女62例，年龄(57±11)岁，术后随访超过1年，根据术后PI-LL分为2组，A组(PI-LL > 10°)47例， B组(PI-LL≤10°)63例。对比两组患者手术前后临床评分(腰背痛目测类比评分和Oswestry 功能障碍指数)及脊柱骨盆矢状位参数的变化，并分析临床症状改善情况和脊柱骨盆影像学参数之间的相关性。 

结果与结论：①两组患者术前骨盆矢状位参数及临床功能的比较无统计学差异(P > 0.05)；②两组手术时间和出血量比较无统计学差异(P > 0.05)；③术后末次随访，与A组比较，B组腰背痛目测类比评分和Oswestry 功能障碍指数明显改善(P=0.000，P=0.005)；腰椎前凸角和骶骨倾斜角也有明显改善(P=0.000，P < 0.05)，骨盆倾斜角恢复的更明显(P=0.000)；④采用 Pearson 相关系数法进行分析，结果显示，腰背痛目测类比评分的改善与骨盆倾斜角 (r=0.209，P=0.008)、腰椎前凸角(r=-0.133，P=0.021)和骶骨倾斜角(r=-0.156，P=0.031)的改善显著相关；骨盆倾斜角与Oswestry 功能障碍指数显著相关(r=0.196，P=0.014)；⑤提示重建腰椎前凸角，并降低骨盆倾斜角，使腰椎前凸角度与骨盆入射角度匹配(即PI-LL≤10°)，可以有效改善患者的临床症状。

https://orcid.org/0000-0001-7375-0273 (方钊) 

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: 腰椎后路融合, 腰椎管狭窄, 矢状位力线, 腰椎前凸角, 骨盆入射角

Abstract: BACKGROUND: Up to date, there is seldom research about the correlation between the harmonious alignment degree of lumbar lordosis and pelvic incidence and the improvement of postoperative clinical symptoms in patients with lumbar stenosis fusion. 
OBJECTIVE: To investigate the harmonious alignment degree of lumbar lordosis and pelvic incidence in patients with lumbar spinal stenosis and fusion, and compare the differences of spinal and pelvic sagittal parameters and clinical outcomes among different harmonious alignment degrees.
METHODS: The medical records of 110 patients with lumbar spinal stenosis (48 males and 62 females, aged 57±11 years) who were treated with posterior lumbar laminar decompression and internal fixation in the Department of Spinal Surgery, Tianjin Union Medical Center from December 2019 to December 2021 were retrospectively analyzed. The postoperative follow-up was more than 1 year. According to the harmonious alignment degree of lumbar lordosis and pelvic incidence, they were divided into two groups: Group A (n=47) (pelvic incidence-lumbar lordosis >10°) and group B (n=63) (pelvic incidence-lumbar lordosis ≤10°). The changes of clinical scores (low back pain visual analog scale score and Oswestry disability index) and spinal and pelvic sagittal parameters before and after surgery were compared between the two groups. The correlation between clinical symptom improvement and spinal and pelvic imaging parameters was analyzed.
RESULTS AND CONCLUSION: (1) There were no significant differences in preoperative pelvic sagittal parameters and clinical function between the two groups (P > 0.05). (2) There were no significant differences in operation time and blood loss between the two groups (P > 0.05). (3) At the last postoperative follow-up, the visual analog scale score and Oswestry disability index in group B were significantly improved compared with group A (P=0.000, P=0.005). Lumbar lordosis and sacral slope were also significantly improved (P=0.000, P < 0.05), and pelvic tilt was more significantly recovered (P=0.000). (4) Pearson correlation coefficient method results showed that the improvement of visual analog scale score of low back pain was significantly correlated with the improvement of pelvic tilt (r=0.209, P=0.008), lumbar lordosis (r=-0.133, P=0.021) and sacral slope (r=-0.156, P=0.031). Pelvic tilt was significantly correlated with Oswestry disability index (r=0.196, P=0.014). (5) It is concluded that reconstructed lumbar lordosis and reduced pelvic tilt for the harmonious alignment (pelvic incidence-lumbar lordosis ≤ 10°) can effectively improve the clinical symptoms of patients.

Key words: posterior lumbar fusion, lumbar spinal stenosis, sagittal alignment, lumbar lordosis, pelvic incidence

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