腰椎前凸矫正程度对节段固定矫形术治疗退变性腰椎侧凸效果的影响

The influence of lumbar lordosis correction on the effect of segmental fixation and correction in the treatment of degenerative lumbar scoliosis

目的探讨腰椎前凸矫正程度对节段固定矫形术治疗退变性腰椎侧凸效果的影响。方法选择退变性腰椎侧凸患者78例作为对象,均行全脊柱正侧位X线检查,完成脊柱骨盆矢状为参数测量,根据骨盆入射角(PI)与腰椎前凸角(LL)差分为观察组(n=45)与对照组(n=33)。所有患者均给予节段固定矫形术治疗,两组术后均进行12个月的随访,比较两组手术指标、ODI量表评分、视觉模拟疼痛(VAS)评分、侧凸Cobb角、冠状位平衡(CVA)、矢状平衡、胸椎后凸角、骨盆入射角及术后并发症发生率。结果两组术后下床活动时间比较差异无统计学意义(P>0.05);观察组手术时间、术中出血量、术后引流量均低于对照组(P<0.05);观察组手术后12个月OID、VAS评分均低于对照组(P<0.05);两组手术后12个月骨盆入射角比较差异无统计学意义(P>0.05);观察组手术后12个月侧凸Cobb角、CVA、矢状平衡均低于对照组(P<0.05);观察组手术后12个月胸椎后凸角高于对照组(P<0.05);观察组手术后下肢深静脉血栓形成、假关节形成、冠状面失衡、矢状面失衡、远近端临近节段病变发生率均低于对照组(P<0.05)。结论腰椎前凸矫正程度在±9°范围内行节段固定矫形术治疗创伤较小,能改善患者腰椎功能,有助于减轻患者疼痛,降低术后并发症发生率,值得推广应用。

Objective To investigate the effect of lumbar lordosis correction on the effect of segmental fixation for degenerative lumbar scoliosis. Methods A total of 78 patients with degenerative lumbar scoliosis treated from May 2017 to January 2018 were enrolled. All patients received full-spine X-ray examination. The sagittal vertebral sagittal parameters were measured. The differences in pelvic index(PI) and lumbar lordosis(LL) were compared between the observation group(n=45 cases) and the control group(n=33 cases). All patients were treated with segmental orthopedic surgery. Both groups were followed up for 12 months. The surgical index, ODI scale score, visual analog pain score(VAS), scoliosis Cobb angle, and coronal balance were compared between the two groups. CVA, sagittal balance, thoracic kyphosis, pelvic angle of incidence, and postoperative complication rate were also compared. Results There was no significant difference in the time of getting out of bed between the two groups(P>0.05). The operation time, intraoperative blood loss and postoperative drainage volume were significant shorter(or less) than the control group(P<0.05). The OID and VAS scores of the observation group were significantly lower than those of the control group 12 months after operation(P<0.05). There was no significant difference in pelvic angle of incidence between the two groups after surgery(P>0.05). Cobb angle, CVA, and sagittal balance were significantly lower in the observation group than in the control group(P<0.05). The thoracic kyphosis angle was significantly higher in the observation group 12 months after surgery than in the control group(P<0.05). The incidence of deep vein thrombosis, pseudoarticular formation, coronal imbalance, sagittal imbalance, and proximal segmental lesions in the lower extremities were significantly lower in the observation group than those in the control group(P<0.05). Conclusion The degree of lumbar lordosis correction in the range of ±9° within the range has small trauma, can improve the lumbar function, reduce pain and the incidence of postoperative complications.