摘要
[目的]探讨伴局部冠状面失平衡(local coronal imbalance,LCI)的退变性腰椎滑脱症影像学特征及对手术疗效的影响。[方法]回顾性分析2010年1月~2015年3月在本院行经椎间孔椎体间融合手术(TLIF)治疗且随访>2年的114例L4/5退变性滑脱患者,其中男21例、女93例;年龄39~73岁(平均50.50岁)。根据在术前腰椎X线片上是否伴LCI现象将患者分为非LCI组和LCI组。于术前、术后和末次随访时测量矢状面和冠状面参数。矢状面参数包括滑脱率、滑脱角、椎间隙相对高度和腰椎前凸角;冠状面参数包括冠状面侧凸角、L4倾斜角、椎间隙楔变角、冠状面失平衡。采用t检验比较两组间影像学的差异。[结果]本组患者15例(13.16%)伴有LCI现象。术前LCI组和非LCI组滑脱率分别为(21.35±4.12)%和(24.27±4.70)%、椎间隙相对高度分别为(0.27±0.03)和(0.23±0.09)、腰椎前凸角分别为(47.39±10.54)°和(42.11±11.60)°,两组比较差异均有统计学意义(P<0.05);术前LCI组冠状面侧凸角、冠状面失平衡、L4倾斜角和椎间隙楔变角均显著高于非LCI组(P<0.05)。经TLIF术后,两组患者术后及末次随访时各影像学指标较术前均明显改善。但术后和末次随访时LCI组滑脱率改善显著低于非LCI组(P<0.05),滑脱角、椎间隙高度、腰椎前凸角比较未见差异(P>0.05);术后LCI组冠状面失平衡显著高于非LCI组,冠状面侧凸角、L4倾斜角和椎间隙楔变角差异均无统计学意义(P>0.05),而末次随访时冠状面参数组间比较差异均无统计学意义(P>0.05)。[结论]伴有LCI的DS患者伴有腰椎侧凸和椎间隙塌陷,TLIF术式可有效矫正伴LCI患者冠状面侧凸和失衡,但其滑脱改善率低于非LCI组。
[Objective] To investigate the radiographic characteristics and surgical effect of local coronal imbalance（LCI）in degenerative spondylolisthesis（DS）. [Methods] A retrospective study was conduct on 114 patients who underwent transforaminal lumbar interbody fusion（TLIF） for L（4/5） degenerative spondylolisthesis between January 2010 and March 2015. Of them,21 males and 93 females aged from 39 to 73 years with an average of 50.5 years. The enrolled patients were divided into two groups, the non-LCI group and LCI group, based on whether or not local coronal imbalance was noted in preoperative X-rays.Slip percentage（SP）, slip angle（SA）, disc height（DH）, lumbar lordosis（LL）, coronal scoliotic angle（CSA）, L4 tilting angle（L4 TA）, disc wedging angle（DWA） and coronal imbalance（CI） were measured and compared between the two groups. [Results]LCI phenomenon was noted in 15 patients, accounted for 14.9% of the 114 patients. The preoperative local deformity parameters, including SP（21.3%±4.1% vs. 24.2%±4.7%, P〈0.05）, DH（0.27±0.03 vs. 0.23±0.09, P〈0.05） and LL（47.3°±10.5° vs.42.1°±11.6°, P〈0.05）, showed significant differences between the non-LCI group and LCI group. In terms of coronal parameters, the preoperative CSA, L4 TA, DWA and CI were significantly higher in the LCI group than non-LCI group. After TLIF procedure, both the non-LCI group and LCI group got significant improvements in clinical and radiographic parameters compared with those before operation, but the improvement rats in the LCI group was significantly inferior to those of in non-LCI group（P〈0.05）. However, no significant differences were observed between them in SA, DH and LL postoperatively and at the latest follow up（P〉0.05）. Although the postoperative CI in the LCI group was significantly higher than the non-LCI group（P〈0.05）, no significant differences in postoperative CSA, L4 TA and DWA were noticed between the two groups（P〉0.05）. In addition, no differenc
作者
杨成林
石志才
徐宏伟
YANG Cheng-lin1,SHIZhi-cai2,XU Hong-wei1(1 Department of Orthopedics, People＇s Hospital of Changxing County, Changxing 313100, China; 2 Department of Orthopedics, Changhai Hospital, Navy Military Medical University, Shanghai 200433, China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2018年第9期786-791,共6页
Orthopedic Journal of China
关键词
退变性腰椎滑脱
局部冠状面失平衡
经椎间孔椎体间融合
degenerative lumbar spondylolisthesis, local coronal imbalance, transforaminal lumbar interbody fusion
