伴与不伴弥漫性特发性骨质增生症的腰椎管狭窄症患者脊柱骨盆参数的比较

Comparison of spine-pelvic parameters between lumbar spinal stenosis with and without diffuse idiopathic skeletal hyperostosis

目的 :探讨弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)对腰椎管狭窄症(lumbar spinal stenosis,LSS)患者脊柱骨盆矢状面参数的影响。方法 :回顾性分析2014年1月~2017年6月于南京鼓楼医院行腰椎后路全椎板切除减压椎间融合手术的伴DISH的LSS患者40例,其中男23例,女17例,年龄51~75岁(65.1±7.3岁)。同时选取年龄及性别匹配且接受相同术式的不伴DISH的LSS患者40例作为对照组,其中男23例,女17例,年龄51~75岁(64.7±7.1岁)。两组患者性别、年龄、责任节段分布均无统计学差异(P>0.05)。分别测量两组患者术前胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状面平衡(sagittal vertical axis,SVA)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、腰骶角(lumbar-sacral angle,LSA)、腰5入射角(L5 incidence,L5I)等脊柱骨盆参数,并用术前VAS评分和ODI评分评估入选对象的生活质量。采用独立样本t检验比较两组患者脊柱骨盆参数的差异及生活质量的差异。结果:伴DISH的LSS患者的术前SVA显著低于不伴DISH的LSS患者(20.0±38.7mm vs.40.0±46.3mm,P=0.039),而TK(27.2°±10.7°vs 25.5°±16.0°)、LL(48.1°±13.7°vs 47.1°±13.5°)、PI(51.4°±14.1°vs 52.5°±13.9°)、PT(18.0°±8.0°vs 19.0°±7.6°)、SS(33.6°±9.5°vs 34.4°±7.8°)、LSA(17.0°±12.0°vs 18.4°±6.7°)及L5I(22.4°±9.8°vs 24.7°±11.9°)两组均无统计学差异(P>0.05)。伴DISH患者术前腰痛和下肢痛VAS评分及ODI评分(分别为5.6±1.0,6.5±1.3,36.9±4.9)均高于不伴DISH组患者(分别为5.4±1.2,6.2±1.7,36.8±5.0),但差异均无统计学意义(P>0.05)。结论:与不伴DISH的LSS患者相比,伴DISH的LSS患者SVA显著降低,TK、LL、PI、PT、SS、LSA及L5I等其他脊柱骨盆矢状面参数无显著差异。

Objectives： To evaluate the effects of diffuse idiopathic skeletal hyperostosis（DISH） on the spine-pelvic parameters of lumbar spinal stenosis（LSS） patients. Methods： A total of 40 LSS patients with DISH from January 2014 to June 2017 was retrospectively reviewed. There were 23 males and 17 females,aged 51 to 75 years with a mean age of 65.1 ±7.3. Another 40 LSS patients without DISH were selected as control group. There were 23 males and 17 females, aged 51 to 75 years with a mean age 64.7 ±7.1. There was no statistically significant difference in gender, age or responsible levels（P〈0.05）. The spinal-pelvic parameters including thoracic kyphosis（TK）, lumbar lordosis（LL）, sagittal vertical axis（SVA）, pelvic incidence（PI）,pelvic tilt（PT）, sacral slope（SS）, lumbar-sacral angle（LSA）, L5 incidence（L5 I） were measured accordingly. The scores of VAS and ODI were assessed for each patient. The independent t test was used to analyze the difference between two groups. Results： The SVA of LSS patients with DISH was significantly lower than thatof LSS patients without DISH（20.0±38.7 mm vs. 40.0±46.3 mm, P=0.039）. There were no significant differences between two groups in TK（27.2° ±10.7° vs 25.5° ±16.0°）, LL（48.1° ±13.7° vs 47.1° ±13.5°）, PI（51.4° ±14.1° vs52.5°±13.9°）, PT（18.0°±8.0° vs 19.0°±7.6°）, SS（33.6°±9.5° vs 34.4°±7.8°）, LSA（17.0°±12.0° vs 18.4°±6.7°） and L5 I（22.4°±9.8° vs 24.7°±11.9°）（P〈0.05）. LSS patients with DISH were associated with both higher VAS scores of back pain and lower limbs pain, and higher ODI score than control group（5.6±1.0 vs 5.4±1.2, 6.5±1.3 vs6.2±1.7, 36.9±4.9 vs 36.8±5.0）. However, the difference was not statistically significant（P〈0.05）. Conclusions：SVA is significantly reduced in LSS patients with DISH compared to those without DISH. There are no significant difference between two groups in TK, LL, PI, PT, SS, LSA and L5 I. In addition, DISH seems to show no significant effect on the quality of life of LSS patients.