脊柱矫形手术在改善成人脊柱畸形患者站立平衡中的作用

The Role of Spinal Orthopedic Surgery in Improving the Standing Balance of Adult Patients with Spinal Deformity

为了探讨脊柱矫形手术在改善成人脊柱畸形患者站立平衡中的作用,2011年1月至2016年3月,本研究选择了68例成人脊柱畸形患者作为研究对象,所有患者均采用后路脊柱融合术治疗。通过测量患者手术前后的冠状面(Cobb角,冠状面垂直轴和躯干偏移)和矢状面平衡参数(C7SVA,胸椎后凸,重力线,骨盆倾斜,骨盆入射角和骨盆入射角-腰椎前凸角),并考察患者的脊柱侧凸研究学会患者问卷(SRS22)和Oswestry功能障碍指数问卷表(ODI)评分,本研究发现术后2年随访时患者的Cobb角和躯干偏移显著小于术前(p<0.05),然而冠状面垂直轴在手术前后无显著差异(p>0.05)。术后2年随访时的C7SVA、重力线、骨盆倾斜、骨盆入射角-腰椎前凸角显著小于术前(p<0.05),然而,胸椎后凸和骨盆入射角在手术前后无显著变化(p>0.05)。术后2年随访时的SRS22量表总均分(4.0±0.6)显著高于术前(3.3±0.7)。并且,除了心理健康在手术前后无显著差异之外,SRS22评分的其他4个维度(疼痛,功能,自我形象和满意度)在术后2年随访时均显著升高(p>0.05)。患者术后2年随访时的ODI评分(32.0±9.8)%显著低于术前(60.5±11.4)%,差异有统计学意义(t=7.868,p=0.001)。患者术后2年随访时的ODI评分(13.28±1.21)显著高于术前(7.65±0.81),差异有统计学意义(t=11.225,p=0.001)。后路脊柱融合术可显著改善成人脊柱畸形患者的冠状面平衡和矢状面平衡,并降低患者的疼痛程度、改善患者的脊柱功能和神经功能。

To investigate the role of spinal orthopedic surgery in improving the standing balance of adult patients with spinal deformity,From January 2011 to March 2016,68 adult patients with spinal deformity were selected as subjects.All patients were treated with posterior spinal fusion.In this study,the coronal plane(Cobb angle,vertical axis and trunk deviation of coronal plane)and sagittal balance parameters(C7 SVA,chest kyphosis,gravity line,pelvic tilt,pelvic incident angle and pelvic incident angle-lumbar kyphosis angle)were measured before and after operation,and the(ODI)scores of SRS22 and Oswestry dysfunction index questionnaire were investigated.It was found that the Cobb angle and trunk deviation of the patients at 2 years after operation were significantly lower than those before operation,but there was no significant difference in the vertical axis of coronal plane before and after operation(p>0.05).C7 SVA,gravity line,pelvic tilt,pelvic angle of incidence-lumbar lordosis at 2 years follow-up were significantly less than preoperative(p<0.05),however,thoracic kyphosis and pelvic angle of incidence did not change significantly before and after surgery(p>0.05).The total mean SRS22 scale(4.0±0.6)at 2 years follow-up was significantly higher than that before surgery(3.3±0.7).Moreover,except for the absence of significant differences in mental health before and after surgery,the other four dimensions of SRS22 scores(pain,function,self-image,and satisfaction)were significantly increased at 2 years follow-up(p>0.05).The ODI score(32.0±9.8)%at 2 years follow-up was significantly lower than that before surgery(60.5±11.4)%,and the difference was statistically significant(t=7.868,p=0.001).The ODI score(13.28±1.21)at 2 years follow-up was significantly higher than that before surgery(7.65±0.81),and the difference was statistically significant(t=11.225,p=0.001).The preliminary results of this study have shown that posterior spinal fusion can significantly improve the coronal balance and sagittal balance in patients with adult spinal deformity,and reduce the patient’s pain level and improve the patient’s spinal function and nerve function.