摘要
目的探讨改良整体形态与平衡评分(modified global alignment and proportion,M-GAP)预测短节段腰椎融合术后邻近节段退变(adjacent segment degeneration,ASD)的可行性。方法回顾性分析2017年1月至2018年12月,我科采用短节段(≤2个节段)经椎间孔腰椎椎体间融合术(transforaminal interbody fusion,TLIF)治疗的腰椎退变患者的资料,随访时间≥2年。记录患者术时年龄、性别、术前体质量指数(body mass index,BMI)、术后随访时间、手术相关数据,术前以及末次随访时的Oswestry功能障碍指数(oswestry disability index,ODI)、腰痛以及腿痛的视觉模拟评分(visual analogue scale,VAS)。在术后3个月全脊柱正侧位X线片上测量所有患者的骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、躯干整体倾斜角(global tilt,GT)及矢状面平衡(sagittal vertical axis,SVA)。根据PI值计算出理想矢状面参数,根据公式得到M-GAP评分。将其分为协调、中等不协调、严重不协调3组。根据术前及随访时的MRI和X线片上改变诊断有无ASD,若随访期内腰痛加重或双下肢神经症状加重,结合影像学表现,诊断为邻近节段病(adjacent segment disease,ASDis)。分析M-GAP评分对短节段腰椎融合术后ASD及ASDis的预测作用。结果共有86例完成了至少2年的随访,其中男42例,女44例;年龄37~85岁,平均(63.7±10.9)岁。59例末次随访时未发生ASD,27例末次随访时发生ASD,10例出现ASDis。根据M-GAP评分,协调、中等不协调及严重不协调的患者分别为55例(64.0%)、24例(27.9%)和7例(8.1%)。术后ASD发生率分别为21.8%(12/55)、41.7%(10/24)和71.4%(5/7),术后ASDis发生率分别为3.6%(2/55)、16.7%(4/24)和57.1%(4/7)。ROC曲线显示M-GAP对ASD的预测有一定准确性(AUC=0.752,P<0.001,95%CI:0.645~0.860),对于ASDis同样具有预测作用(AUC=0.867,P<0.001,95%CI:0.760~0.974)。M-GAP评分不同组间术后ASD发生率的差异有统计学�
Objective To investigate the feasibility of predicting adjacent segment degeneration after short-segment lumbar fusion with modified global alignment and proportion score(M-GAP).Methods We retrospectively reviewed the data of patients after short-segment(≤2 levels)transforaminal interbody fusion for lumbar degeneration from January 2017 to December 2018.All were followed up for more than 2 years in Beijing Xuanwu Hospital.The followings were recorded:age,gender,BMI,follow-up time,operative data,clinical scores and measurements before operation and in the follow-up including Oswestry disability index(ODI)and visual analogue scale(VAS)for low back and leg pain.Values of spinal and pelvic parameters including pelvic incidence(PI),sacral slope(SS),spine lordosis(LL),global tilt(GT)and sagittal vertical axis(SVA)were measured on lateral full-spine X-rays three months after surgery.The ideal sagittal plane parameters were calculated according to PI values.The M-GAP score was obtained.The cohort was divided into three subgroups as proportioned,moderately disproportioned and severely disproportioned group.The diagnosis of adjacent segment degeneration(ASD)was based on preoperative and follow-up MRI and X-ray findings.Combined with imaging findings,ASD was confirmed when the aggravation of lumbar pain or neurological symptoms of both lower limbs occurred.The predictive ability of M-GAP score to ASD and ASDis was also validated.Results A total of 86 patients were enrolled in the cohort,including 42 males and 44 females aged 37-85 years(mean:63.7±10.9 years).Among them,59 patients had no ASD while 27 developed ASD and 10 developed ASDis at the last follow-up visit.According to the M-GAP score,the postoperative sagittal spinopelvic alignment was proportioned in 55(64.0%)cases,moderately disproportioned in 24(27.9%)cases and severely disproportioned in 7(8.1%)cases,and the occurrence of ASD was 21.8%(12/55),41.7%(10/24)and 71.4%(5/7),respectively.And the occurrence of ASDis was 3.6%(2/55),16.7%(4/24)and 57.1%(4/7),respecti
作者
孙文志
王宇
王宝宝
胡海量
孔超
张思韬
鲁世保
SUN Wen-zhi;WANG Yu;WANG Bao-bao;HU Hai-liang;KONG Chao;ZHANG Si-tao;LU Shi-bao(Department of Orthopedics,Xuanwu Hospital,Capital Medical University,Beijing,100053,China)
出处
《中国骨与关节杂志》
CAS
2023年第1期22-28,共7页
Chinese Journal of Bone and Joint
基金
北京市属医学科研院所公益发展改革试点项目(京医研2019-2)。
关键词
腰椎
脊柱融合术
脊柱疾病
Lumbar vertebrae
Spinal fusion
Spinal diseases
