退行性脊柱侧凸畸形患者术前脊柱后方肌群肌力对长节段固定融合后纠正矢状位失衡效果的影响

Effect of muscular strength of posterior spine muscle in patients with degenerative scoliosis on correction of sagittal imbalance after fixation and fusion of long segments

目的探讨退行性脊柱侧凸畸形患者术前脊柱后方肌群肌力对长节段固定融合后纠正矢状位失衡效果的影响。方法选取2013-10—2016-10间深圳平乐骨伤科医院诊断为退行性脊柱侧凸且行长节段固定融合术的100例患者。根据术前腰背肌力量的测试结果分组。将可以完成"小飞燕"动作的45例患者作为A组,将不能完成"小飞燕"动作的55例患者作为B组。分别于入院首日、术后第3天和第24个月行脊柱正侧位X线检查,测量并比较2组患者的矢状位参数、骨盆参数及Oswestry功能障碍指数(ODI)、腰椎JOA评分和胸腰段视觉模拟评分(VAS)。结果 2组患者入院首日各矢状位参数和骨盆参数及ODI、JOA和VAS评分的差异均无统计学意义(P>0.05)。术后第3天,2组各项参数和评分均有较好的改善,2组差异无统计学意义(P>0.05)。随访24个月,末次随访时,B组患者矢状位参数中的SVA、TK、TLK、PJA较A组增大;骨盆参数中PT较A组增大、SS较A组减小;而ODI与VAS评分也较A组差。2组上述指标的差异均有统计学意义(P<0.05)。结论在后方肌群的力量较强的情况下,可以有效维持退行性脊柱侧凸患者长节段固定术后的矢状位失衡纠正效果。

Objective To investigate the effect of muscle strength of posterior spine muscles in patients with degenerative scoliosis on correction of sagittal imbalance after fixation and fusion of long segments.Methods Totally 100 patients were diagnosed as degenerative scoliosis with segmental fixation and fusion in Shenzhen Pingle Orthopedics Hospital from 2013-10 to 2016-10. The patients were divided into two groups according to the pre-operative test results of the lumbar dorsum muscle strength. 45 patients who could complete the "Little Flying swallow" were treated as Group A and 55 patients who could not complete the "Little Flying swallow" as Group B. The first day of admission, the 3 rd day and the 24 th month after operation, the positive and lateral spine X-ray examination was performed. Sagittal parameters, pelvic parameters and Oswestry dysfunction index(ODI), lumbar JOA score and thoracolumbar spine segment visual analogue score(VAS) were measured and compared between the two groups.Results There were no significant difference in sagittal and pelvic parameters and ODI, JOA scores, and VAS scores between the two groups on the first day of admission(P>0.05). On the 3 rd day after operation, the parameters and scores of both groups A and B were improved, but there was no significant difference between the two groups(P>0.05). At the last follow-up, SVA, TK, TLK, and PJA in sagittal parameters of group B patients were greater than those in group A(P<0.05). PT in pelvic parameters was greater than that in group A, and SS was lower than group A(P< 0.05);ODI and VAS scores were also worse than those in group A(P<0.05).Conclusion When the strength of posterior spine muscle group is strong, it can effectively maintain the correct effect of sagittal imbalance after long-segment fixation in patients with degenerative scoliosis.