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叶林辉,刘蔚,倪婷,凡进,殷国勇,邹月芬,蔡卫华.腰椎滑脱症融合术后脊柱矢状面平衡改变与疗效的关系[J].脊柱外科杂志,2018,16(3):129-133,139.
腰椎滑脱症融合术后脊柱矢状面平衡改变与疗效的关系     点此下载全文 (Fulltext)
叶林辉1  2  刘蔚1  倪婷3  凡进1  殷国勇1  邹月芬3  蔡卫华1
1. 南京医科大学第一附属医院骨科, 江苏 210029;
2. 南京市溧水区人民医院骨科, 江苏 211200;
3. 南京医科大学第一附属医院放射科, 江苏 210029
基金项目:国家自然科学基金(81371967);江苏省"六大人才高峰"C类资助项目(2014-WSN-012);江苏省第五期"333工程"培养对象科研项目(2016512)
DOI:10.3969/j.issn.1672-2957.2018.03.001
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摘要:
      目的 探讨经椎间孔腰椎椎间融合术(TLIF)单节段及双节段固定对退行性腰椎滑脱症患者脊柱矢状面参数的影响及其与疗效的关系。方法 收集南京医科大学第一附属医院44例(Ⅰ度32例,Ⅱ度12例)经TLIF治疗的退行性腰椎滑脱症患者的临床及影像学资料,根据手术固定节段分为单节段组(29例)和双节段组(15例)。分析比较术前、术后全脊柱侧位X线片的矢状面参数脊柱骶骨角(SSA)、T1骨盆角(TPA)、腰椎前凸(LL)、骨盆投射(PI)、骨盆倾斜(PT)及骶骨倾斜(SS),以及疼痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分及Oswestry功能障碍指数(ODI)。结果 全部病例均获得随访,随访时间3~10个月,平均6个月。全组患者术后SSA、TPA、LL、SS均较术前增大,PT较术前减小,差异均有统计学意义(P<0.05),VAS评分、JOA评分和ODI均较术前改善,差异均有统计学意义(P<0.05)。单节段组手术前后LL差值、ODI差值与双节段组比较差异有统计学意义(P<0.05),且2组手术前后LL差值与ODI差值均相关。SSA差值在双节段组与VAS评分差值相关,在单节段组二者无相关性。结论 Ⅰ度或Ⅱ度退行性腰椎滑脱症患者通过TLIF治疗可改善脊柱矢状面参数,且单节段固定更有利于术后脊柱矢状面参数的改善。
关键词:腰椎  脊椎滑脱  脊柱融合术  内固定器  肌肉骨骼平衡
Relationship between change of sagittal plane balance and treatment outcomes after internal fxation in lumbar spondylolisthesis    Fulltext
YE Lin-hui1  2  LIU Wei1  NI Ting3  FAN Jin1  YIN Guo-yong1  ZOU Yue-fen3  CAI Wei-hua1
1. Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China;
2. Department of Orthopaedics, Nanjing Lishui People's Hospital, Nanjing 211200, Jiangsu, China;
3. Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China
Fund Project:
Abstract:
      Objective To explore the effects of transforaminal lumbar interbody fusion(TLIF) with single or double segment fixation on sagittal parameters of degenerative lumbar spondylolisthesis and its relationship with clinical outcomes. Methods The clinical and imaging data of 44 patients with degenerative lumbar spondylolisthesis(32 cases of grade Ⅰ and 12 cases of grade Ⅱ) undergoing TLIF in first affiliated hospital of Nanjing medical university were retrospectively analyzed. The patients were divided into single segment group(29 cases) and double segment group(15 cases). The sagittal parameters on the total spine roentgenograph were measured before and after the surgery, including spino-sacral angle(SSA), T1 pelvic angle (TPA), lumbar lordosis(LL), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), and the visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) were evaluated. Results All the patients were followed up for 3 -10 months with an average of 6 months. SSA, TPA, LLA and SS increased, and PT decreased after operation in all the patients, and the differences were statistically significant(P<0.05). The VAS score, JOA score and ODI were significantly improved after operation, and the differences were statistically significant(P<0.05). The LL and ODI difference value in single segment group were more significantly than those in double segment group, and the differences were statistically significant (P<0.05). The LL difference value was correlated with the ODI difference value in 2 groups. The SSA difference value was associated with the VAS score in the double segment group, and there was no correlation between the 2 values in the single segment group. Conclusion GradeⅠorⅡdegree of degenerative lumbar spondylolisthesis treated with TLIF can improve the spinal sagittal parameters, and single segment fixation is more conducive to the postoperative spinal sagittal parameters improved.
Keywords:Lumbar vertebrae  Spondylolysis  Spinal fusion  Internal fixators  Musculoskeletal equilibrium
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