摘要
目的探讨后路长节段内固定术治疗退变性脊柱侧凸术后即刻不同骨盆投射角与腰椎前凸角之差（PI－LL）对术后脊柱侧凸矫正度、生活质量及内固定相关并发症的影响。方法回顾性分析2010年1月至2015年1月于首都医科大学附属北京朝阳医院骨科行后路长节段椎弓根螺钉内固定植骨融合治疗的79例退变性脊柱侧凸患者的资料，男性21例，女性58例，年龄55～72岁，平均（63.4±4.8）岁。将患者按照术后即刻PI－LL的大小，分为〈10°组（25例）、10°～20°组（32例）和〉20°组（22例）。比较手术前后Cobb角、PI－LL、日本骨科协会（JOA）评估治疗分数、Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）、腰椎僵硬功能障碍指数（LSDI）。计量资料比较采用t检验和方差分析，非连续变量采用χ2检验；采用一元线性回归分析比较术后PI－LL与临床疗效及影像学参数的关系。结果所有患者均手术成功，术中无并发症发生。手术时间145～310 min，平均（235.3±42.0）min，出血量300～5 300 ml，平均（1 021±787）ml，住院时间12～18 d，平均（14.5±1.3）d。共4～10个节段进行固定融合，平均（7.0±1.1）个。与术前相比，术后脊柱侧凸Cobb角[（4.2±1.8）°比（20.1±2.7）°]、PI－LL [（16.1±8.6 ）°比（36.0±4.3）°]、JOA（3.0±1.3比5.5±1.2）、ODI（24.4±8.1比62.9±2.7）、VAS（3.0±1.0比6.8±1.3）均降低（t＝18.539～53.826，P值均〈0.01）。与术前相比，〈10°组、10°～20°组和〉20°组患者术后脊柱侧凸Cobb角[（4.1±2.7）°比（19.5±2.7）°、（4.0±1.4）°比（20.2±2.4）°、（4.7±0.9）°比（20.6±3.0）°]（t＝21.148～45.355，P值均〈0.01）和PI－LL[（5.2±2.8）°比（35.8±4.9）°、（17.9±2.9）°比（37.2±3.9）°、（25.8±2.7）°比（34.5±4.0）°]（t＝7.227～38.250，P值均〈0.01）均降低，三组PI－LL的差异有统计学意义（F＝326.16
ObjectiveTo evaluate the influence of PI-LL （pelvic incidence minus lumbar lordosis mismatch） on scoliosis correction, living quality and internal fixation related complications for adult degenerative scoliosis （ASD） after long posterior instrumentation and fusion.MethodsA total of 79 patients with ADS underwent long posterior instrumentation and fusion in the Department of Orthopedics at Beijing Chao Yang Hospital from January 2010 to January 2014 were retrospectively reviewed.There were 21 males and 58 females aging from 55 to 72 years with the mean age （63.4±4.8）years. The patients were divided into three groups according to immediately postoperative PI-LL： PI-LL〈10°, 10°≤PI-LL≤20°, PI-LL〉20°.Compare the Cobb′s angles, PI-LL, Japanese Orthopaedic Association （JOA） score, Oswestry Disability Index （ODI）, Visual Analog Scale （VAS） and Lumbar Stiffness Disability Index （LSDI）. Measurement data were compared via t test and ANOVA, enumeration data were compared via Kruskal-Wallis test, noncontiguous data was performed by χ2 test. Univariate linear regression equation was performed to investigate the relative influences of postoperative PI-LL on postoperative radiographic parameters and clinical outcome.ResultsAll the operations were successful without intraoperative complications. The operation time was 145-310 minutes （235.3±42.0） minutes, the intraoperative blood loss was 300-5 300 ml （1 021±787） ml, the duration of hospital was 12-18 d （14.5±1.3） d. A total of 4 to 10 （7.0±1.1） vertebra levels were fused. Compared to preoperative, the Cobb′s angle of scoliosis （（4.2±1.8）° vs. （20.1±2.7）°）, PI-LL （（16.1±8.6）° vs. （36.0±4.3）°）, JOA （3.0±1.3 vs. 5.5±1.2）, ODI （24.4±8.1 vs. 62.9±2.7）, VAS （3.0±1.0 vs. 6.8±1.3） were significantly decreased postoperative （t=18.539~53.826, P〈0.01）. Compared to preoperative, postoperative Cobb′s angle of scoliosis （（4.1±2.7）° vs. （19.5±2.7）°, （4.0
作者
孙祥耀
海涌
张希诺
Sun Xiangyao Hai Yong Zhang Xinuo(Department of Orthopedics, Beijing Chao Yang Hospital, Capital Medical University, Beijing 100020, China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2017年第6期435-440,共6页
Chinese Journal of Surgery
关键词
脊柱侧凸
脊柱融合术
长节段内固定术
骨盆投射角
腰椎前凸角
Scoliosis
Spinal Fusion
Long posterior instrumentation and fusion
Pelvic incidence
Lumbar lordosis
