摘要
目的探索成人脊柱畸形(adult spinal deformity,ASD)患者手术前、后冠状面失衡情况及相关因素,明确术前参数及手术因素是否对术后即刻冠状面失衡造成影响。方法回顾性分析67例长节段固定融合手术(≥4椎体)ASD患者的手术前、后的影像学资料,记录截骨处、截骨级别及融合节段,在站立位脊柱全长正、侧位X线片上测量影像学参数,冠状面:侧凸Cobb’s角度、侧凸类型(左或右)、侧凸顶椎旋转度、顶椎位置、C7铅垂线(C7 plumb line,C7PL)到骶骨中分线(central sacral vertical line,CSVL)的距离即冠状面平衡差距(coronal balance distance,CBD);侧凸纠正(dCobb=术前Cobb-术后Cobb);顶椎旋转纠正(d顶椎旋转=术前顶椎旋转度-术后顶椎旋转度);矢状面:胸椎后凸角(thoracic kyphosis,TK)、胸腰段后凸角(thoracic lumber kyphosis,TLK)、腰椎前凸角(lumber lordosis,LL)、骶骨角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、矢状面平衡(sagittal vertical axis,SVA),手术前、后相应参数做配对t检验。post-CBD与其它参数做相关回归分析。根据患者术前侧凸类型及CBD分为A组(-30.00 mm<CBD<30.00 mm)、B组(CBD>30.00 mm或CBD<-30.00 mm,C7PL位于侧凸凹侧)及C组(CBD>30.00 mm或CBD<-30.00 mm,C7PL位于侧凸凸侧)三组,F检验分析三组相关参数,χ2检验比较手术前、后冠状面失衡比,三组患者性别比及相关手术参数。结果本组67例手术前、后侧凸Cobb’s角[(-8.85±24.56)°vs.(-2.99±9.53)°]、顶椎旋转度[(2.1±0.99)°vs.(0.91±0.6)°]、TK[(17.25±12.80)°vs.(21.87±9.73)°]、TLK[(20.31±15.31)°vs.(9.98±7.64)°]、LL[(22.74±19.78)°vs.(39.13±12.05)°]、SS[(22.58±12.82)°vs.(30.63±10.63)°]、PT[(24.27±11.25)°vs.(16.22±9.04)°]、SVA[(48.58±52.03)mm vs.(13.29±38.37)mm],差异均有统计学意义(P<0.05);PI、CBD差异无统计学意义(P>0.05)。所有患者手术前、后冠状面失衡率分别为31.34%(21/67)和40.30%(27/67),术后�
Objective To explore radiological parameters correlated to post-operation coronal imbalance,and to investigate whether pre-operation coronal imbalance affects post-operation coronal imbalance following posterior spinal fusion with instrument and osteotomy operation.Methods The study included 67 patients(13 males and 54 females)with ASD who underwent posterior long-segment spinal fixation(at least 4 vertebrae)and osteotomy.The age ranged from 45 to 79 years(mean:63.93±8.46 years).Medical records of 67 ASD patients were reviewed.Radiological parameters of the spine were measured on the pre-and post-operation anteroposterior and lateral radiographs.Coronal plane:curve Cobb’s angle,type of curve(left or right),degree of apical vertebra rotation,location of apical vertebra/disc,coronal balance distance(CBD;the distance between C7PL and CSVL),modified degree of the curve(pre-Cobb-post-Cobb),modified degree of the apical vertebra rotation(pre-rotation degree-post-rotation degree).Sagittal plane:thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),sagittal vertical axis(SVA).Pre-and post-operational radiological parameters were compared by paired samples t-test respectively.Relations between post-CBD and other radiological parameters were analyzed by linear-regression test.All patients were divided into three groups according to the type of the curves and the pre-CBD.A:-30.00 mm<CBD<30.00 mm;B:CBD>30.00 mm or CBD<-30.00 mm,and C7PL shifted to the concave side of the curve;C:CBD>30.00 mm or CBD<-30.00 mm,and C7PL shifted to the convex side of the curve.Radiological parameters of the 3 groups were analyzed by F test.The ratios of gender,curve type,pre-and post-operational coronal imbalance were compared byχ2-tset.Results Results of paired samples t-test showed that differences of radiological parameters pre-and post-operation were significant(P<0.05):curve Cobb’s angles[(-8.85±24.56)°vs.(-2.99±9.53)°],degree of apical vertebra rotation[(2.1±0
作者
张子方
宋凯
吴兵
张国莹
迟鹏飞
王兆翰
王征
ZHANG Zi-fang;SONG Kai;WU Bing;ZHANG Guo-ying;CHI Peng-fei;WANG Zhao-han;WANG Zheng(Department of Orthopaedics,the General Hospital of PLA,Beijing,100853,China)
出处
《中国骨与关节杂志》
CAS
2019年第10期726-732,共7页
Chinese Journal of Bone and Joint
关键词
脊柱弯曲
脊柱融合术
冠状面失衡
影像学参数
Spinal curvatures
Spinal fusion
Coronal imbalance
Radiological parameters
