腰椎椎管狭窄症患者手术前后脊柱-骨盆矢状位参数变化

Analysis of sagittal spinopelvic parameters in patients with lumbar spinal stenosis before and after operation

目的研究腰椎椎管狭窄症(LSS)患者手术前后脊柱-骨盆矢状位参数的变化,并分析参数之间的相关性。方法回顾性分析2015年1月—2015年7月在北京朝阳医院接受腰椎后路减压植骨融合内固定术治疗的63例LSS患者临床资料,选取同期60名健康成年志愿者作为对照组。采用疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评估LSS患者疼痛和骨盆功能改善情况。测量并比较志愿者及LSS患者术前和末次随访时全脊柱站立侧位X线片上骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、矢状位垂直轴(SVA)、腰椎前凸角(LL)和胸椎后凸角(TK)等参数,分析LSS患者手术前后脊柱-骨盆曲度变化情况;采用Pearson相关分析探讨参数间的相关性。结果末次随访时,LSS患者VAS评分和ODI均较术前明显改善,差异有统计学意义(P<0.05)。LSS患者术前PT和SVA高于对照组,SS、LL、TK低于对照组,差异均有统计学意义(P<0.05),PI差异无统计学意义(P>0.05);末次随访时LSS患者PT、SS、LL、SVA和TK等参数均较术前改善,差异有统计学意义(P<0.05),PI无明显变化。末次随访时LSS患者各项指标与对照组相比,差异均无统计学意义(P>0.05)。LSS患者无论术前还是末次随访时,PI分别与PT、SS、LL及TK呈正相关,与SVA无相关性。结论手术治疗可改善LSS患者PT、SS、LL、SVA和TK等参数,改善脊柱-骨盆曲度和生理功能,缓解疼痛症状。PI不受手术影响且与PT、SS、LL呈正相关,术前可通过PI值预估PT、SS、LL的理想矫正范围,指导手术,获得满意的手术疗效。

Objective To study the changes of sagittal spinopelvic parameters in the patients with lumbar spinal stenosis(LSS)before and after operation,and analyze the correlation between the parameters.Methods The data of 63 LSS patients who underwent posterior lumbar decompression,bone grafting,fusion and internal fixation in Beijing Chao-yang Hospital from January 2015 to July 2015 were retrospectively analyzed,and 60 healthy adult volunteers were selected as the control group.The visual analogue scale(VAS)score and Oswestry dysfunction index(ODI)were used to evaluate the pain and spinopelvic function.The pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal vertical axis(SVA),lumbar lordosis(LL)and thoracic kyphosis(TK)were measured on whole spine standing lateral roentgenograph of the control group and the LSS patients at pre-operation and the final follow-up,and compared between the LSS patients and the control group,and the changes of spinopelvic curvature were analyzed in LSS patients before and after operation.Pearson correlation analysis were used to explore the relationship between spinopelvic parameters.Results At the final follow-up,VAS score and ODI of the LSS patients were significantly improved compared with those before operation,all with a statistical significance(P<0.05).The preoperative PI,PT and SVA in LSS patients were significantly higher than those in the control group,and SS,LL and TK were lower than those in the control group,all with a statistical significance(P<0.05);the difference in PI was not statistically significant(P>0.05).Compared with pre-operation,PT,SS,LL,SVA and TK were significantly improved at the final follow-up in the LSS patients,all with a statistical significance(P<0.05),while PI did not change significantly.At the final follow-up,there was no significant difference in spinopelvic parameters between the LSS patients and the control group(P>0.05).In the LSS patients,whether at pre-operation or final follow-up,PI was positively correlated with PT,SS,LL and TK,but not with SVA.Conclusions Surgical treatment can improve the PT,SS,LL,SVA,TK and spinopelvic curvature and physiological function,and relieve pain symptoms.PI is not affected by surgery and positively correlated with PT,SS and LL.The ideal correction range of PT,SS and LL can be estimated by PI value before operation to guide the operation and obtain a satisfactory surgical outcome.