经椎弓根截骨螺钉固定修复胸腰椎后凸畸形:脊柱-骨盆参数的相关性分析

Pedicle subtraction osteotomy for repairing thoracolumbar degenerative kyphosis: correlation of spino-pelvic parameters

背景:退变性胸腰椎后凸畸形患者因矢状面失平衡导致腰痛,进而严重影响其生活质量,截骨矫形重建此类患者的矢状面尤为重要。目的:探讨经椎弓根椎体截骨矫形螺钉置入内固定修复退变性胸腰椎后凸畸形患者术后生活质量与脊柱-骨盆参数变化的关系及临床意义。方法:回顾性分析2010年5月至2014年10月在河北省沧州中西医结合医院行L2经椎弓根椎体截骨矫形螺钉置入内固定的59例退变性胸腰椎后凸畸形患者的临床资料。所有患者手术前后均摄站立位全脊柱正侧位X射线片。统计测量所有患者术前、术后X射线平片的胸椎后凸角、腰椎前凸角、T1骨盆角、矢状面平衡、骨盆投射角、骶骨倾斜角和骨盆倾斜角;术前术后运用SF-36量表评估患者的生活质量并进行对比。结果与结论:(1)脊柱-骨盆相关参数中,除骨盆投射角外,其余参数手术前后相比差异均有显著性意义(P<0.01);就SF-36量表各维度而言,术后评分均高于术前(P<0.01);(2)腰椎前凸角的变化与骨盆倾斜角、骶骨倾斜角、矢状面平衡存在线性相关,骨盆倾斜角的变化与骶骨倾斜角、身体疼痛维度及总体健康状况维度存在线性相关,矢状面平衡的变化与腰椎前凸角、身体疼痛、总体健康状况存在相关性,T1骨盆角的变化与腰椎前凸角、矢状面平衡、身体疼痛及总体健康状况也存在相关性;(3)结果表明,经椎弓根椎体截骨螺钉置入内固定能够有效重建退变性胸腰椎后凸畸形患者的脊柱-骨盆矢状面形态,缓解疼痛,显著改善患者的生活质量。

BACKGROUND： Thoracolumbar degenerative kyphosis could experience severe lumbar back pain due tosagittal plane imbalance, thereby affecting quality of life. Thus, it is very important to reconstruct spino-pelvic profile in these patients. OBJECTIVE： To explore the relationships between life quality and spino-pelvic parameters following pedicle subtraction osteotomy for thoracolumbar degenerative kyphosis and the clinical significance. METHODS： Between May 2010 and October 2014, 59 patients with thoracolumbar degenerative kyphosis undergoing L2 pedicle subtraction osteotomy in Cangzhou Hospital of Integrated Traditional and Western Medicine were retrospectively reviewed. Anteroposterior and lateral X-ray films of all patients during standing were photographed before and after surgery. The pre-and post-operative thoracic kyphosis, lumbar lordosis, sagittal imbalance, T1 pelvic angle, pelvic incidence, sacral slope and pelvic tilt were measured in all patients. The patients＇ quality of life was evaluated using SF-36 preoperatively and postoperatively. RESULTS AND CONCLUSION：（1） Significant differences were observed in the improvement of thoracic kyphosis, lumbar lordosis, pelvic tilt, sacral slope and sagittal imbalance（P〈0.01）. With respect to SF-36, postoperative SF-36 score was higher than preoperative postoperative SF-36 score（P〈0.01）.（2） The alteration of lumbar lordosis showed significant correlation with the change of pelvic tilt, sacral slope and sagittal imbalance. The change of pelvic tilt exhibited cardinal correlation with the change of sacral slope, body pain and general health. The improvement of sagittal imbalance significantly correlated with the improvement of lumbar lordosis, body pain and general health. The improvement of T1 pelvic angle significantly correlated with the improvement of lumbar lordosis, sagittal imbalance, body pain and general health.（3） Pedicle subtraction osteotomy can effectively restore spino-pelvic sagittal profile, improve the life quality and relieve pain for the patients with thoracolumbar degenerative kyphosis.