重度腰椎滑脱术后骨盆-脊柱参数与临床症状的相关分析

The relationship between variation of postoperative spinopelvic parameters and clinical symptoms for patients with severe isthmic spondylolisthesis

目的研究重度峡部裂腰椎滑脱患者手术前后骨盆-脊柱参数的变化与临床症状改善的相关性。方法回顾性分析2000—2013年中南大学湘雅二医院收治的60例L5重度峡部裂滑脱患者的临床资料,根据术后Oswestry评分改善率的不同分为高改善率组(改善率>50%)和低改善率组(改善率<50%),测量分析两组滑脱百分比、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、髋关节-S1水平距离(SFHD)、髋关节-S1垂直距离(SFVD)、腰椎前凸角(LL)、胸椎后凸角(TK)、C7铅垂线-骶骨后角距离(SC7D)、腰骶角(Dub-LSA)、腰骶关节角(LSJA)等数据。结果高改善率组PT、LL、SFHD、SC7D、LSJA、PT/SS、LL/TK、SFHD/SFVD均低于低改善率组(P<0.05),而SS、TK、SFVD、Dub-LSA均高于低改善率组(P<0.05)。PT、LL、SFHD、SC7D、LSJA与Oswestry评分改善率呈显著负相关,负相关程度依次为SC7D>LL>PT>SFHD>LSJA(P<0.05);SS、TK、SFVD、Dub-LSA与Oswestry评分改善率呈显著正相关,正相关程度依次为:Dub-LSA>SS>SFVD>TK(P<0.05);PT/SS、SFHD/SFVD、LL/TK与Oswestry评分改善率呈显著负相关,负相关程度依次为:PT/SS>LL/TK>SFHD/SFVD(P<0.05),这3个参数比值与术后Oswestry评分改善率的相关性均大于单个参数与术后评分改善率的相关性(P<0.05)。结论重度腰椎滑脱患者术后临床症状与骨盆-脊柱参数关系密切,临床症状改善率与PT、LL、SFHD、SC7D、LSJA、PT/SS、SFHD/SFVD、LL/TK呈负相关,与SS、TK、SFVD、Dub-LSA呈正相关。提示对于此类患者,术前应充分评估可能影响术后症状改善的因素,优先考虑矫正影响较大的参数,并设计合理手术方案,以提高疗效。

Objectives To investigate the relationship between variation of postoperative spinopelvic parameters and clinical symptom improvement rate for patients with severe isthmic spondylolisthesis. Methods Clinical data of 60 patients with severe L5 isthmic spondylolisthesis treated from 2000 to 2013 in the Second Xiangya Hospital of Central South University were collected. According to different postoperative clinical symptom improvement rates by compared with Oswestry scoring, patients were divided into 2 groups： high improvement rate group （postoperative clinical symptoms improvement rate 〉50%） and low improvement rate group （postoperative clinical symptoms improvement rate 〈50%）. In each group, spondylolisthesis percentage were calculated, spinopelvic parameters were analyzed on full spine X-rays including pelvic incidence （PI）, pelvic tilt （PT）, sacral slope （SS）, lumbar lodosis （LL）, thoracic kyphosis （TK）, sacro-femoral horizontal distance （SFHD）, sacro-femoral vertical distance （SFVD）, sacro-C7 plumb line distance （SC7D）, Dubousset lumbosacral angle （Dub-LSA）, and lumbosacral joint angle （LSJA）. Results Compared with those spinopelvic parameters in low improvement rate group, PT, LL, SFHD, SC7D, LSJA, PT/SS, LL/TK, SFHD/SFVD were significantly smaller, while SS, TK, SFVD, Dub-LSA were significantly greater in high improvement rate group （P 〈0.05）. Multiple linear regression analysis results showed that PT, LL, SFHD, SC7D, LSJA had significantly negative correlations with postoperative clinical symptom improvement rate, and degree of negative correlation showed SC7D〉LL〉PT〉SFHD〉LSJA accordingly （P 〈0.05）; SS, TK, SFVD, Dub-LSA had significantly positive correlations with postoperative clinical symptom improvement rate, and the degree of positive correlations showed Dub-LSA〉SS〉SFVD〉TK accordingly （P 〈0.05）; PT/SS, SFHD/SFVD, LL/TK had significantly negative correlation with postoperative clinical symptom improvement rate, and the degree of negative correlation showed PT/SS〉LL/TK〉SFHD/SFVD accordingly （P 〈0.05）, correlations among the three above parameter relative values and improvement rate were higher than correlations among single parameters and improvement rate （P 〈0.05）. Conclusions For patients with severe isthmic spondylolisthesis, close relationship has been found between postoperative clinical symptom improvement rate and spinopelvic parameters. The improvement rate shows significantly negative correlation with postoperative PT, LL, SFHD, SC7D, LSJA, PT/SS, SFHD/SFVD, LL/TK and significantly positive correlation with postoperative SS, TK, SFVD, Dub-LSA. The results indicate that the impact factors which may affect postoperative symptom improvement should be evaluated sufficiently before the surgery, parameters which influence the correction effect seriously should be considered firstly, so as to design favorable surgical planning to improve therapeutic effects.