矢状面平衡参数与脱出腰椎间盘重吸收关系的回顾性研究

Sagittal Balance Parameters Correlate with Resorption of the Lumbar Disc Extrusion:Results of a Retrospective Study

目的研究腰椎间盘脱出以及脱出重吸收后腰椎-骨盆矢状面参数相应的改变。方法收集2010年5月-2019年3月按北美脊柱协会(NASS)推荐的诊断标准、诊断为腰椎间盘脱出患者的资料,依据随访时影像检查显示的脱出椎间盘吸收程度,将患者分为吸收组〔突出椎间盘完全消失,或残留的椎间盘局限在按美国密歇根州立大学(Michgan State University,MSU)学者提出的影像学分型的1级之内〕和未吸收组(脱出间盘未发生变化,或虽有缩小但突出仍超过1级),站立位照片确定骨盆-脊柱参数〔包括骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)和腰椎前凸角(LL)〕,通过多因素方差分析比较两组前后各参数之间的变化。结果共计67例腰椎间盘脱出症患者纳入本研究,患者症状都得到了满意的缓解。其中吸收组37例,平均年龄42.6岁,男21例,女16例,腰4~5椎间盘脱出13例,腰5骶1椎间盘脱出24例,平均随访22个月;未吸收组30例,平均年龄40.8岁,男19例,女11例,其中腰4~5椎间盘脱出12例,腰5骶1椎间盘脱出18例,平均随访21个月。两组比较,年龄、性别、吸烟史、慢性病史、突出节段、MSU分型、随访时间等基线情况差异均无统计学意义(P>0.05)。在随访结束时,吸收组矢状面30例移位全部消失,突出间盘从初始的MSU分型2级19例、3级18例变为吸收后残留间盘全部局限在1级以内;未吸收组矢状面移位从20例减少到14例,突出间盘从初始的MSU分型2级21例、3级9例变为2级27例,3级3例。治疗前两组比较,各脊柱-骨盆参数(PI、SS、PT、LL)差异均无统计学意义(P>0.05);治疗后(随访结束时)比较,两组PI差异无统计学意义(P>0.05),吸收组SS、LL均值大于未吸收组,PT均值小于未吸收组,差异有统计学意义(P<0.05)。组内比较,吸收组治疗前后PI、SS、PT差异无统计学意义(P>0.05),LL治疗后变大,差异有统计学意义(P<0.05);未吸收组治疗前后脊柱-骨盆各参数差异均无统计学意义(P>0.05)。结论间盘脱出重吸收后导致脊柱-骨盆参数发生相应的变化,反之,脊柱-骨盆参数的改变表明腰椎能更好地缓冲负荷,减轻间盘压力,从而导致间盘重吸收的发生。

Objective A retrospective study was designed to explore the relationship between the satittal spinopelvic alignment in patients with lumbar disc extrusion and spontaneous resorption.Methods From May 2010 to March 2019,referring to NASS evidence-based clinical guidelines,patients with lumbar disc extrusion were enrolled in this retrospective study,according to the degree of herniation size during the follow-up,the patients were divided into two groups:resorption(group R:the herniated disc completely disappeared or the herniation size was grade 1 according to Michgan State University(MSU)classification)and nonresorption(group N:the herniated disc remain unchanged or the herniation size overpass grade 1),spinopelvic parameters(including the pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),lumbar lordosis(LL))were determined on standing profile radiographs of the lumbar spine and pelvis,and mean values were compared using the multi-factor analysis of variance.Results This study included 67 patients with lumbar disc extrusion.There were 37 in group R(the average age was 42.6 years),21 males and 16 females,13 cases at L4-5 level and 24 cases at L5-S1 level,follow-up 22 months,and 30 in group N(the average age was 40.8 years),19 males and 11 females,12 cases at L4-5 level and 18 cases at L5-S1 level,follow-up 21 months,at the follow up time,there symptoms were all satisfactorily relieved.There were no signifcant differences in age,gender,smoking history,chronic medical history,prominent segmnet,MSU classification,follow up time and other baseline conditions between two groups(P>0.05).At the follow-up,in group R,all 30 cases of sagittal displaced disc disappeared,the herniated disc changed from the initial MSU classification of grade 2 in 19 cases and grade 3 in 18 cases to the post-absorption residual disc,which were limited to grade 1;in group N,20 cases of sagittal displaced disc reduced to 14 cases,the herniated disc changed from the initial MSU classification of grade 2 in 21 cases and grade 3 in 9 cases to grade 2 in 27 cases and grade 3 in 3 cases.There was no significant difference in spinopelvic parameters between the two groups before the treatment(P>0.05).At the follow-up,there was no significant difference in PI between the two groups(P>0.05);the SS and LL in group R were bigger than those in group N,the PT in group R was smaller than that in group N,and the difference was statistically significant(P<0.05).Compared within the same group,before treatment and follow-up,there were no significant differences in PI,SS and PT in group R,but a bigger LL(P<0.05);no significant differences in all the parameters in group N were found.Conclusion Resorption may result in pinopelvic parameter changes,which suggest that the lumbar spine is better at cushioning against load,reducing the disc pressure,and leading to resorption of the herniated disc.