退变性腰椎侧凸患者矫形术后颈椎矢状面参数代偿性改变研究

Compensatory changes of sagittal parameters of cervical vertebrae after degenerative lumbar scoliosis surgery

目的观察退变性腰椎侧凸患者后路矫形术后颈椎矢状面参数的代偿性改变及其与远期疗效的关系。方法自2010年1月-2016年1月,行后路矫形手术治疗退变性腰椎侧凸患者103例,测量患者术前、术后3个月、术后2年的脊柱全长站立侧位片上矢状面相关参数:C1-2颈椎前凸(UCL)、C3-7颈椎前凸(LCL)、颌眉角(CVBA)、C2-7矢状垂直轴(SVA)、T1倾斜角(T1S)、胸廓入口角(TIA)、T5-12胸椎后凸角(TK)、腰椎前凸(LL),骶骨倾斜角(SS),骨盆倾斜角(PT)和骨盆入射角(PI),并应用颈椎功能障碍指数(NDI)调查问卷评估患者的生活质量改变情况。结果本组患者腰椎矫形术后脊柱矢状面参数发生显著改变(P<0. 05),Pearson相关性分析提示:LL的改变与LCL、CL及C2-C7 SVA、TIA及C7-S1 SVA等颈椎矢状面参数的继发性改变密切相关(P<0. 0001,r>0. 5),且上述改变与NDI评分的改善相关。结论退变性腰椎侧凸后路矫形术后颈椎矢状面参数发生明显代偿性改变,且整体矢状面参数的代偿改变越趋向正常范围,患者远期从矫形手术中获益的可能性越大。

Objective To observe the compensatory changes of cervical sagittal parameters after posterior orthopedic surgery in patients with degenerative lumbar scoliosis( DLS) and its intrinsic relationship with long-term outcome. Methods From January 2010 to January 2016,103 patients with DLS who underwent posterior orthopedic surgery in our hospital were selected in this study,Preoperative and postoperative clinical data and imaging data of the patients were collected. The parameters were measured on the postoperative lateral X-ray film before surgery,3 months and 2 years after operation respectively such as C1-2 upper cervical lordosis( UCL),C3-7 lower cervical lordosis( LCL),and Chin-brow to vertical angle( CVBA),C2-7 Sagittal vertical axis( SVA),T1 slope( T1S),thoracic inlet angel( TIA),T5-T12 thoracic kyphosis( TK),lumbar lordosis( LL),sacral slope( SS),pelvic tilt( PT) and pelvic incidence( PI),and neck disability index( NDI) questionnaire was used to assess changes in the patients’ quality of life.Results Significant changes in the sagittal parameters of the spine were observed in this group after lumbar orthopedic surgery( P<0.05). Pearson correlation analysis indicated that the changes of LL and LCL were closely related with CL and C2-C7 SVA,TIA and C7-S1 SVA( P<0. 0001,r>0. 5),and such changes were associated with the improving of NDI scores. Conclusions DLS patients after orthopedic surgery will have significant compensatory changes in the sagittal parameters of the cervical spine. And the more these changes tend to the normal range,the greater the likelihood that the patients will benefit from surgery in the long run.