基于Roussouly分型的脊柱形态和GAP评分对成人脊柱畸形术后临床疗效的影响

The Influence of Roussouly Classification Based Spinal Morphology and GAP Score on Postoperative Clinical Efficacy of Adult Spinal Deformities

目的评估成人脊柱畸形(ASD)手术前后的Roussouly矢状面脊柱形态及全脊柱序列比例(GAP)评分对术后临床疗效的影响。方法回顾性分析2016年1月至2021年12月在宁夏医科大学总医院行手术治疗的72例ASD患者临床资料,其中男性20例,女性52例,年龄(46.9±19.0)岁。将纳入患者按照“当前”[依据骶骨倾斜角(SS)]和“理论”[依据骨盆入射角(PI)]Roussouly分型脊柱形态进行划分。根据一个恒定参数(PI)判断出患者“理论”形态,然后将此种类型的理想形态参数与实际参数作对比,若术后3个月患者的“当前”Roussouly脊柱形态与其“理论”Roussouly脊柱形态各项参数均符合则归入匹配组,否则归入非匹配组。根据相关参数计算两组患者手术前后GAP评分,并收集术前、术后3个月和末次随访时的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及术前和末次随访时SRS-22评分(包括总分、疼痛、功能、自我形象、心理健康和治疗满意度),同时记录患者随访时机械并发症发生情况。比较两组患者的影像学参数、GAP评分、临床疗效评分及机械并发症中的差异。结果72例ASD患者术前以RoussoulyⅠ型和Ⅱ型脊柱形态为主,术后以RoussoulyⅡ型和Ⅲ型为主。所有患者术后影像学参数和临床疗效评分较术前均得到改善(P均<0.05)。组间比较,非匹配组末次随访骨盆倾斜角和躯干整体倾斜角大于匹配组(P均<0.05),术后3个月及末次随访,匹配组GAP评分均低于非匹配组(P均<0.05),匹配组较非匹配组在术后3个月和末次随访有更好的VAS评分、ODI评分及SRS-22评分(包括总分、疼痛、功能和治疗满意度)(P均<0.05)。匹配组术后机械并发症发生率更低(P<0.05),腰椎前凸顶点位于理想位置可降低机械并发症发生率。结论ASD术后脊柱矢状面匹配理想Roussouly分型的患者临床疗效和GAP评分更好、机械并发症发生率更低,PI术中应尽可能矫正至理想Roussouly分型脊柱形态。

Objective To evaluate the Roussouly sagittal spinal morphology before and after surgery for adult spinal deformity(ASD)and the impact of global alignment and promotion(GAP)score on postoperative clinical efficacy.Methods A retrospective analysis was conducted on the clinical data of 72 ASD patients who underwent surgical treatment in our hospital from January 2016 to December 2021,including 20 males and 52 females,with an average age of(46.9±19.0)years old.Patients were classified according to their current[based on pelvic incidence angle(PI)]and theoretical[based on sacral inclination angle(SS)]Roussouly classification of spinal morphology.The patient’s“theoretical”shape was determined based on PI(a constant parameter),and then the ideal shape parameters of this type were compared with the actual parameters.If the patient’s“current”Roussouly spine shape 3 months after surgery matched all the parameters of their“theoretical”Roussouly spine shape,they were assigned to the matching group.Otherwise,they were assigned to the non matching group.The GAP scores before and after surgery for two groups of patients were calculated based on relevant parameters,and the visual analogue scale(VAS),Oswestry disability index(ODI),and SRS-22 scores(including total score,pain,function,self-image,mental health,and treatment satisfaction)at preoperative,postoperative 3 months,and final follow-up were collected.Simultaneously,the occurrence of mechanical complications during patient follow-up was recorded.The differences between two groups in imaging parameters,GAP score,functional score,and mechanical complications were compared.Results Among the 72 ASD patients in this group,the preoperative spinal morphology was mainly RoussoulyⅠandⅡ,while postoperative morphology was mainly RoussoulyⅡandⅢ.All patients showed significant improvement in postoperative imaging parameters and clinical efficacy scores compared to preoperative levels(P all<0.05).Inter group comparison showed that the non matching group had a higher pelvic tilt angle and overall trunk tilt angle at the last follow-up than the matching group(P all<0.05).The GAP score of the matching group was lower than that of the group at 3 months and the last follow-up(P all<0.05).The matching group had better VAS score,ODI score,and SRS-22 score(including total score,pain,function,and treatment satisfaction)than the non matching group at 3 months and the last follow-up,and the difference was statistically significant(P all<0.05).The incidence of postoperative mechanical complications was lower in the matching group(P<0.05),and the optimal position of the lumbar lordosis vertex during surgery can reduce the incidence of mechanical complications.Conclusion After ASD surgery,patients who match the ideal Roussouly classification of the spinal sagittal plane have better clinical efficacy and GAP scores,lower incidence of mechanical complications,and should be corrected to the ideal Roussouly classification of the spinal morphology as much as possible during the PI surgery.