非融合减压手术对退行性腰椎管狭窄症患者脊柱矢状面失衡的影响

Effect of non-fusion Decompression Surgery on spinal sagittal Imbalance in Patients with degenerative lumbar spinal Stenosis

目的探讨研究非融合减压手术对退行性腰椎管狭窄症患者脊柱矢状面失衡的影响。方法选取2016年2月至2018年2月在湖南师范大学附属第一医院采用非融合减压手术治疗的84例退行性腰椎管狭窄症患者为研究组,选取同期在本院采用减压融合手术治疗的76例患者为对照组,记录患者手术时间、术中出血量、住院时间、下床时间;骨盆入射角、骶骨斜坡、骨盆倾斜水平;矢状垂直轴(SVA),腰椎前凸、胸椎后凸水平;苏黎世跛行问卷(ZCQ);视觉模拟评分;oswestry功能障碍指数。根据矢状垂直轴将研究组患者分为平衡组(30例)、轻度失衡组(34例)和重度失衡组(20例)。并比较三组骨盆入射角、骶骨斜坡、骨盆倾斜水平;矢状垂直轴(SVA),腰椎前凸、胸椎后凸水平;视觉模拟评分;oswestry功能障碍指数。结果研究组患者手术时间、术中出血量、住院时间和下床时间均短于对照组,差异有统计学意义(P<0.05)。两组治疗前,骨盆入射角、骶骨斜坡、骨盆倾斜、矢状垂直轴、腰椎前凸、胸椎后凸水平,跛行调查问卷得分、视觉模拟评分、功能障碍指数差异无统计学意义(P>0.05);治疗后,两组骨盆入射角、骨盆入射角水平差异无统计学意义(P>0.05);骨盆倾斜、腰椎前凸、胸椎后凸水平高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05);矢状垂直轴水平、跛行调查问卷得分、视觉模拟评分、功能障碍指数优于治疗前,且研究组优于对照组,差异有统计学意义(P<0.05)。三组患者治疗前、治疗后骨盆入射角、骶骨斜坡、骨盆倾斜差异无统计学意义,且组间比较,差异无统计学意义(P>0.05);治疗后轻度失衡组和重度失衡组矢状垂直轴较治疗前均明显降低,且三组治疗后组间比较,差异有统计学意义(P<0.05);三组患者腰椎前凸角度较治疗前均明显增大,且三组治疗后组间比较,差异有统计学意义(P<0.05);轻度失衡组胸椎后凸角度较治疗前明显增大,差异有统计学意义(P<0.05)。治疗前三组组间视觉模拟评分比较,差异无统计学意义(P>0.05),治疗后,三组视觉模拟评分均低于治疗前,且轻度失衡组、重度失衡组高于平衡组,差异有统计学意义(P<0.05)。治疗前三组组间功能障碍指数比较,差异无统计学意义(P>0.05),治疗后,三组功能障碍指数均低于治疗前,差异有统计学意义(P<0.05)。结论非融合减压手术可明显改善退行性腰椎管狭窄症患者脊柱矢状面失衡状况,同时脊柱矢状面失衡是造成患者疼痛感增强的重要因素。

Objective To investigate the effect of non-fusion decompression on sagittal imbalance in patients with degenerative lumbar spinal stenosis.Methods From February 2016 to February 2018,84 patients with degenerative lumbar spinal stenosis who were treated with non-fusion decompression surgery in the First Affiliated Hospital of Hunan Normal University were selected as the study group,and 76 patients who were treated with decompression and fusion surgery in our hospital at the same time were selected as the control group,and the operation time,intraoperative blood loss,hospitalization time,and bedtime of patients,pelvic angle of incidence,sacral clivus,and pelvis tilt level,sagittal vertical axis(SVA),lumbar lordosis,thoracic kyphosis level,ZCQ,visual simulation score,oswestry dysfunction index were recorded.According to the sagittal vertical axis,the patients in the study group were divided into balance group(30 cases),mild imbalance group(34 cases)and severe imbalance group(20 cases).The incidence angle of pelvis,sacral clivus and obliquity of pelvis,sagittal vertical axis(SVA),lumbar lordosis,thoracic kyphosis level;visual simulation score,oswestry dysfunction index were compared among the three groups.Results The operation time,intraoperative bleeding,hospital stay and time out of bed of the patients in the study group were shorter than those in the control group,the difference was statistically significant(P<0.05).Before treatment,there was no significant difference between the two groups in pelvic incidence angle,sacral clivus,pelvic tilt,sagittal vertical axis,lumbar lordosis,thoracic kyphosis level,claudication questionnaire score,visual analog score and dysfunction index(P>0.05);After treatment,there was no significant difference in pelvic incidence angle and pelvic incidence angle between the two groups(P>0.05),the levels of pelvic obliquity,lumbar lordosis and thoracic kyphosis were higher than those before treatment,and those in the study group were higher than those in the control group,with statistical significance(P<0.05);The sagittal vertical axis level,claudication questionnaire score,visual simulation score,dysfunction index were lower than those before treatment,and the study group was lower than the control group,the difference was statistically significant(P<0.05).There was no significant difference in pelvic angle of incidence,sacral clivus and pelvic tilt between the three groups before and after treatment,and there was no significant difference between the groups(P>0.05);After treatment,the sagittal vertical axis of the mild imbalance group and the severe imbalance group decreased significantly compared with that before treatment,and the difference between the three groups after treatment was statistically significant(P<0.05);The lumbar lordosis angle of the three groups was significantly increased compared with that before treatment,and the difference between the three groups after treatment was statistically significant(P<0.05);The thoracic kyphosis angle in the mild imbalance group was significantly increased compared with that before treatment,with a statistically significant difference(P<0.05).Before treatment,there was no significant difference in visual simulation scores among the three groups(P>0.05).After treatment,the visual simulation scores of the three groups were lower than before treatment,and the mild imbalance group and severe imbalance group were higher than the balance group,with a statistically significant difference(P<0.05).There was no significant difference in the dysfunction index between the three groups before treatment(P>0.05),after treatment,the dysfunction index of the three groups was lower than that before treatment,and the difference was statistically significant(P<0.05).Conclusion Non-fusion decompression surgery can significantly improve the sagittal imbalance of the spine in patients with degenerative lumbar spinal stenosis,and the sagittal imbalance of the spine is an important factor causing increased pain in patients.