腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的相关性研究

Study of the Relationship between Low Back Pain and Changes of Lumbar Spine Sagittal Alignment after Lumbar Spine Fusion

目的探讨分析腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的相关性。方法回顾性分析我院于2010年2月～2011年6月收治的38例接受腰椎融合术的腰椎退行性疾病且术后发生下腰痛患者的临床资料，于所有患者出院后进行为期24个月的随访。在手术前及随访期间收集所有患者站立位X线片腰椎前凸的Cobb角，并分析其与患者下腰痛程度之间的相关性。结果术后12个月及24个月与手术前的腰椎矢状位Cobb角比较，均无统计学意义（分别为t=0．042，P=0．967及t=0．268，P=0．789）；术后12个月及24个月的腰椎矢状位Cobb角与正常角度的差值与手术前比较均无统计学意义（分别为t=0．450，P=0．900及t=0．174，P=0．862）。术后12个月及24个月的VAS评分与手术前相比，有明显改善（分别为t=2．838，P=0．006及t=3．251，P=0．002），而术后12个月及24个月的ODI评分与手术前相比也有明显改善（分别为扣2．300，P=0．024及t=3．320，P=0．001）。术后12个月及24个月所有患者的腰椎前凸丢失与VAS评分及ODI评分均呈正相关（P〈0．05）。结论腰椎前凸角度的丢失与腰椎退行性疾患腰椎融合术后的腰痛关系密切，手术过程中腰椎前凸的重建十分重要。

Objective To study the relationship between low back pain and changes of lumbar spine sagittal alignment after lumbar spine fusion. Methods Retrospective analysis was carried out in the clinical data of 38 patients who accepted lumbar spine fusion and got low back pain who came to our hospital from February 2010 to June 2011. Anterioposterior and lateral radiography of standing lumbar spine was taken during the follow-up and the lumbar lordosis Cobb angles were measured on radiography. Pain degrees were assessed by visual analog scale （VAS） and Oswestry disability index （ODI）. The relationship between the changes of Cobb angle and lumbar sagittal plane curve was analyzed. Also the relationship between back pain degree and Cobb angle was examined. Results VAS and ODI at 12 months and 24 months after the surgery was statistically better than that before the surgery ; loss of lumbar sagittal lordosis was positively correlated with VAS and ODI 12 months and 24 months after operation. Conclusions Loss of lumbar sagittal lordosis is closely related with low back pain in patients accepted lumbar spine fusion. And lumbar lordosis reconstruction during surgery is important.