重度发育不良性L5滑脱患者腰骶后凸矫正与生活质量的相关性分析

Correlation analysis between correction of lumbosacral kyphosis deformity and quality of life of patients with high-grade L5 dysplastic spondylolisthesis

目的:分析重度发育不良性L5滑脱患者腰骶部后凸畸形矫正程度对患者术后生活质量的影响。方法:回顾分析2009年6月~2018年1月收治的31例重度发育不良性L5滑脱并接受单纯后路减压复位椎间融合手术治疗患者的资料。男6例,女25例,年龄10~31岁(16.7±4.7岁)。单节段固定11例,两节段固定20例。均获得2年以上随访(24~76个月)。通过术前术后改良腰骶角(modified lumbosacral angle,mLSA)和腰骶后凸矫正指数(kyphosis correction index,KCI)评估腰骶部后凸畸形矫正程度,应用简体中文版SRS-22量表的功能活动、疼痛、自我形象和心理健康等四个维度评估患者生活质量,分析术前和术后末次随访时mLSA、KCI与生活质量评分之间的相关性。结果:末次随访时所有病例滑脱程度、腰骶后凸畸形较术前均有不同程度矫正,滑脱率由术前(67.8±11.7)%降低到术后末次随访的(24.8±7.9)%,mLSA由术前的后凸18.3°±4.9°矫正为末次随访时的前凸9.8°±8.1°,KCI为0.64±0.17。末次随访时患者SRS-22量表各维度评分较术前明显改善(P<0.05)。末次随访时SRS-22量表四个维度与总体评分与术前mLSA无显著相关性(P>0.05),自我形象评分与末次随访时的mLSA相关性较好(r=0.684,P=0.000),与KCI中等相关(r=0.481,P=0.006),其余维度评分与末次随访时的mLSA和KCI无显著相关性(P>0.05)。结论:复位矫正后凸畸形能够改善重度发育不良性L5滑脱患者生活质量,尤其是患者的自我形象评分,手术时除关注滑脱复位率,还应重视腰骶部后凸畸形的矫正。

Objectives:To analyze the effect of correction of lumbosacral kyphosis deformity on the quality of life of patients with high-grade L5/S1 dysplastic spondylolisthesis.Methods:To retrospectively analyze the data of 31 patients diagnosed with high-grade L5 dysplastic spondylolisthesis and treated with reduction and fusion by a single posterior approach from June 2009 to January 2018.The modified lumbosacral angle(mLSA)and kyphosis correction index(KCI)were used to evaluate the degree of lumbosacral kyphotic deformity.The quality of life was evaluated by SRS-22 questionnaire in simplified Chinese.Subscales measuring pain,self-image,mental health,function and the total score were calculated before and after surgery.Correlation between the SRS-22 score and the degree of lumbosacral kyphotic deformity was analyzed by Pearson′s coefficients.Results:At the last follow-up,the slip percentage and lumbosacral kyphosis of all patients in this group were corrected at different degrees.Pre-and post-operative slippage rates were respectively(67.8±11.7)%and(24.8±7.9)%.The mLSA was corrected from kyphotic 18.3°±4.9°before surgery to lordotic 9.8°±8.1°at the final follow-up,and the KCI was 0.64±0.17.The four dimensions of the SRS-22 scale and the total score at the final follow-up were higher than those before surgery.The final follow-up mLSA correlated with better self-image(r=0.684)and the lumbosacral KCI was moderately correlated with self-image score(r=0.481).Conclusions:Reduction and correction of lumbosacral kyphosis can improve the health-related quality of life of patients with severe dysplastic lumbar spondylolisthesis,especially the self-image score.In addition to the slippage degree during surgery,attention should also be paid to the correction of rotational deformities.