摘要
目的探讨经骶2骶髂螺钉(secondsacralalar-iliac,S2AI螺钉)固定的退变性脊柱侧后凸患者骨盆入射角(pelvicincidence,PI)变化及其生活质量。方法回顾性分析2015年1月至2019年1月25例接受S2AI螺钉固定治疗的退变性脊柱侧后凸畸形患者的病历资料,男4例,女性21例;年龄50~68岁,平均(58.84±6.03)岁。术前冠状面侧凸Cobb角平均43.96°±20.14°,矢状面局部后凸Cobb角平均为32.36°±15.32°。均采用后路矫形长节段融合固定术,且均经双侧骶髂关节应用S2AI螺钉固定至骨盆。按末次随访时PI较术后增加是否>5°分组,末次随访PI增加>5°者为升高组,末次随访PI< 5°者为稳定组。升高组共13例患者,男2例,女11例;平均年龄(57.23±6.06)岁。稳定组共12例患者,男2例,女10例;平均年龄(60.58±5.73)岁。影像学评价采用术前、术后及末次随访时的侧凸Cobb角、腰椎前凸角(lumbar lordosis,LL)、局部后凸Cobb角(regional kyphosis,RK)、矢状面平衡(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)及骶骨倾斜角(Sacral slop,SS)。临床疗效评价采用术前及末次随访时的Oswestry功能障碍指数(Oswestry disability index,ODI)和健康调查简表(the MOS item short from health survey, SF-36)。手术前后及末次随访影像学参数及临床疗效比较采用配对t检验,两组间影像学参数及临床疗效比较采用独立样本t检验。结果两组患者的性别分布、年龄、术前侧凸Cobb角、SVA等的差异均无统计学意义。术后患者均获得满意疗效且随访期间维持良好。升高组患者PI术前平均为56.92°±14.47°,术后减少至42.69°±14.23°,较术前明显降低(t=8.08,P=0.0001),平均减少14.23°±6.35°;末次随访时PI平均为51.62°±14.53°,较术后明显增加(t=-5.23,P=0.0001),平均增加8.92°±6.16°。稳定组患者PI术前平均为46.21°±12.26°,术后减少至37.08°±12.99°,较术前明显降低(t=15.794,P=0.0001),平均�
Objective To evaluate the clinical outcome and health related quality of life in degenerative patients with kyphoscoliosis who underwent S2AI placement and identify the potential risk factors of pelvic incidence variation postoperative and at last follow-up. Methods The present study reviewed degenerative patients with kyphoscoliosis who accepted surgery utilized S2AI screw between January 2015 and January 2019. 25 patients were included in our study, 4 males and 21 females, among these patients, the mean age were 58.84±6.03 years, range from 50-68 years. All patients were conducted long fusion distal to pelvis utilizing S2AI screws. According to the variation of pelvic incidence at last follow-up, we divided patients into two subgroups: 1) Group I: Patients' pelvic incidence increased more than 5 degree compared with post-operation. 2) Group S: Patients' pelvic incidence varied less than 5 degree compared with post-operation. 13 patient (2 male, 11 female;mean age: 57.23±6.06 years) were categorized into group I, and 12 patients (2 male, 10 female;mean age: 60.58±5.73 years) were categorized into group S.Cobb′s angle, lumbar lordosis(LL), regional kyphosis(RK), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slop(SS) were recorded at pre-operation, post-operation and last follow up. The MOS item short from the health survey(SF-36) and Oswestry disability index (ODI) were also recorded at pre-operation and last follow up. Results There was no statistical difference in gender, age, preoperative Cobb angle, SVA between two groups. In group I, pelvic incidence were decreased postoperatively and increased at the last follow-up (56.92°±14.47° vs 42.69°±14.23° vs 51.62°±14.53°, P<0.05). In group S, pelvic incidence were decreased postoperatively (46.21°±12.26° vs 37.08°±12.99°, P<0.05) and remained stable at the last follow up (37.08°±12.99° vs 37.17°±13.34°, P>0.05). Cobb angle (46.08°±20.52° vs 19.96°±12.64° vs 20.28°±12.01°), RK (32.88°±15.28° vs-12.16
作者
曾昌淳
朱泽章
王斌
俞杨
钱邦平
邱勇
刘臻
Zeng Changchun;Zhu Zezhang;Wang Bin;Yu Yang;Qian Bangping;Qiu Yong;Liu Zhen(Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nangjing 210008, China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第16期982-991,共10页
Chinese Journal of Orthopaedics
基金
江苏省卫计委青年科研课题(Q201510)
江苏省临床医学中心(YXZXA2016009).
