老年退变性腰椎管狭窄症合并矢状面失衡症的手术治疗及近期疗效

The surgical treatment and preliminary postoperative outcomes of degenerative lumbar spinal stenosis combined with sagittal imbalance syndrome

目的 分析老年退变性腰椎管狭窄症 (degenerative lumbar spinal stenosis,DLSS) 合并矢状面失衡症 (sagittal imbalance syndrome,SIS) 手术的近期疗效。方法 回顾性分析 2016 年 5 月至 2020 年 5 月,在我院接受手术治疗并随访 1 年以上的 DLSS 合并 SIS 患者的临床和影像学资料。其中接受腰椎管减压、矢状面失衡矫正和内固定融合手术的患者为 A 组,共 16 例,其中男 3 例,女 13 例,平均年龄 (67.4±3.0) 岁;仅行腰椎管减压和内固定融合手术的患者为 B 组,共 20 例,其中男 6 例,女 14 例,平均年龄 (65.0±2.1) 岁。术前与末次随访时测量并比较两组的影像学参数、腰背疼痛视觉模拟评分 (visual analogue scale,VAS) 和腰椎 Oswestry 功能障碍指数 (oswestry disable index,ODI)。结果 两组患者在年龄、性别分布、术前影像学参数、VAS 评分和 ODI 方面差异均无统计学意义。末次随访时,A 组侧凸 Cobb’s 角、冠状面平衡 (coronal balance,CB)、胸椎后凸 (thoracic kyphosis,TK)、胸腰椎后凸 (thoracolumbar kyphosis,TLK)、腰椎前凸 (lumbar lordosis,LL)、骨盆腰椎匹配 (pelvic incidence-lumbar lordosis,PI-LL)、骶骨倾斜率 (sacral slope,SS),矢状面躯干偏移 (sagittal vertical axis,SVA)、T1骨盆角 (T1pelvic angle,TPA)、VAS 评分和 ODI 均得到显著改善,而 B 组仅 Cobb’s 角、LL、SS、PI-LL、SVA、VAS 评分和 ODI 改善明显。A 组 SVA 矫正、ODI 改善均显著优于 B 组。随访中 B 组有 7 例出现近端交界性后凸 (proximal junctional kyphosis,PJK),A 组未发现继发 PJK 的患者 (P=0.008)。结论 当 DLSS 合并 SIS 时应向上延长融合节段矫正矢状面失衡,充分改善患者生活质量,减少术后内固定相关并发症的发生。

Objective To analyze the preliminary postoperative outcomes of degenerative lumbar spinal stenosis (DLSS) combined with sagittal imbalance syndrome (SIS) in elderly patients.Methods A retrospective review of the clinical and radiographic data of patients with DLSS and SIS was performed.All patients underwent surgical treatment from May 2016 to May 2020,and were followed up for more than 1 year.Patients after lumbar canal decompression,sagittal imbalance correction and posterior spinal fusion (PSF) were assigned to Group A,including 3 males and 13 females with a mean age of (67.4±3.0) years.Those who underwent decompression and PSF only were assigned to Group B,including 6 males and 14 females with a mean age of (65.0±2.1) years.Patients’pre-operative and post-operative radiographic parameters and living function were collected and compared between the two groups.Results Patients in the two groups were comparable in age,gender distribution,preoperative radiographic parameters,Visual Analogue Scale (VAS) score and Oswestry Disable Index (ODI) assessment.At the latest follow-up,Cobb’s angle,coronal balance (CB),thoracic kyphosis (TK),thoracolumbar kyphosis (TLK),lumbar lordosis(LL),PI-LL,sacral slope (SS),sagittal vertical axis (SVA),T1pelvic angle (TPA),VAS and ODI were significantly improved in Group A,while only Cobb’s angle,LL,SS,PI-LL,SVA,VAS and ODI were obviously changed in Group B.Improvement of SVA and ODI were significantly greater in Group A than Group B.During follow-up,7 patients in Group B were found with proximal junctional kyphosis (PJK),while no PJK was found in Group A.Conclusions It is necessary to lengthen fusion level to correct the sagittal imbalance when DLSS combines with SIS,which could not only improve the sagittal alignment and living quality but also decrease fixation-related complications.