减压植骨融合内固定治疗退变性腰椎滑脱:基于脊柱骨盆参数预测患者的功能预后

Posterior lumbar interbody fusion for degenerative lumbar spondylolisthesis:prediction of functional prognosis of patients based on spinopelvic parameters

背景:手术是治疗退变性腰椎滑脱的常用方式,但是部分患者出现术后健康生活质量改善不良,而患者术前脊柱骨盆参数与术后患者健康生活质量的关系尚不明确。目的:基于脊柱骨盆参数探讨退变性腰椎滑脱患者术后健康生活质量改善不良的术前预测因素。方法:回顾性分析2014年6月至2017年9月符合标准的退变性腰椎滑脱症患者186例,均行腰椎后路减压植骨融合内固定术,其中男87例,女99例。①所有患者术前拍摄站立位脊柱全长X射线片,并测量矢状面脊柱骨盆参数:胸椎后凸角、腰椎前凸角、骨盆投射角、骨盆倾斜角、骶骨倾斜角、L4倾斜角、L5倾斜角和脊柱矢状位平衡。②末次随访采用SF-36量表对患者进行健康生活质量评定,并根据评分分为生活质量改善良好组(Good组)和生活质量改善不良组(Poor组)。比较两组患者的基本资料及脊柱骨盆参数,并应用Logistic回归及ROC曲线分析患者健康生活质量差的术前预测因素。结果与结论:①全部病例均获得随访,随访时间20-26个月,平均24个月。②Good组127例,Poor组59例,生活质量改善不良患者占32%。组间比较显示Poor组的骨盆入射角、骨盆倾斜角、腰椎前凸角、脊柱矢状位平衡均大于Good组(P<0.05),两组患者骶骨倾斜角、L4倾斜角、L5倾斜角及胸椎后凸角无统计学差异(P>0.05)。③Logistic回归分析确定了3个术前预测因素:盆投射角(P<0.001)、骨盆倾斜角(P<0.001)和脊柱矢状位平衡(P=0.026)。④ROC曲线分析显示盆投射角>52.18°,骨盆倾斜角>25.23°,脊柱矢状位平衡>3.84 cm是术后患者生活质量改善不良的危险因素,其中骨盆倾斜角的AUC值(0.944)最大。提示对于术前伴有危险因素的患者应该引起足够的重视。

BACKGROUND:Surgery is a common way to treat degenerative lumbar spondylolisthesis,but some patients have poor postoperative health and quality of life.The relationship between preoperative spine pelvic parameters and postoperative healthy quality of life is not clear.OBJECTIVE:To investigate the preoperative predictors of postoperative poor improvement in healthy life quality for patients with degenerative lumbar spondylolisthesis based on spinopelvic parameters.METHODS:A retrospective analysis was performed on 186 patients with degenerative lumbar spondylolisthesis who met the criteria and underwent posterior lumbar interbody fusion surgery from June 2014 to September 2017,including 87 males and 99 females.(1)All patients were examined by the whole spine X-ray films in a standing position and sagittal spinopelvic parameters were measured,including pelvic incidence,pelvic tilt,sacral slope,lumbar lordosis,thoracic kyphosis,L4 slope,L5 slope,and sagittal vertical axis.(2)At the last postoperative follow-up,SF-36 was used to evaluate the healthy life quality of the patients,and the patients were divided into good group and poor group according to this score.The basic data and spinopelvic parameters of the two groups were compared and the preoperative predictors of poor quality of life were analyzed by Logistic regression and receiver operating characteristic curve analysis.RESULTS AND CONCLUSION:(1)All cases were followed up for 20 to 26 months,with an average of 24 months.(2)There were 127 cases in the good group and 59 cases in the poor group,with poor improvement in quality of life accounting for 32%.Group comparison revealed that sacral slope,lumbar lordosis,pelvic tilt,and sagittal vertical axis were larger in the poor group than in the good group(P<0.05).There was no significant difference in sacral slope,L4 slope,L5 slope,and thoracic kyphosis between the two groups(P>0.05).(3)Logistic regression analysis identified three preoperative predictors:pelvic incidence(P<0.001),pelvic tilt(P<0.001)and sagittal vertical axis(P=0.026).(4)Receiver operating characteristic curve analysis showed that pelvic incidence>52.18°,pelvic tilt>25.23°,and sagittal vertical axis>3.84 cm were risk factors for poor improvement in quality of life in postoperative patients,and the AUC value of pelvic tilt(0.944)was the largest.Sufficient attention should be paid to patients with preoperative risk factors.