Roussouly分型预测退变性脊柱侧凸长节段内固定术后机械性并发症的有效性分析

Effectiveness of Roussouly classification in predicting mechanical complications after long-segment fixation in the treatment of adult degenerative scoliosis

目的对Roussouly分型在预测退变性脊柱侧凸(adult degenerative scoliosis,ADS)长节段内固定矫形术后机械性并发症方面的准确性进行评估,对其特点进行进一步分析。方法回顾性分析2016年12月至2018年10月,于河北中石油中心医院和首都医科大学附属北京朝阳医院接受长节段内固定术治疗的71例ADS患者的临床资料。测量的影像学参数主要包括:冠状面Cobb’s角(coronal Cobb’s angle,CA)、骨盆投射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、胸腰段后凸角(thoracolumbar kyphosis,TLK)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、矢状位垂直轴(sagittal vertical axis,SVA)、腰椎前凸椎体数量(the number of vertebrae included in the lordosis,NVL)、腰椎前凸顶点(the lumbar sagittal apex,LA)、胸椎后凸与腰椎前凸拐点(inflexion point,IP)以及腰椎前凸分布指数(lordosis distribution index,LDI)。根据有机械性并发症将患者分为机械性并发症(mechanical complication,MC)组(n=34)与无机械性并发症(no mechanication,NMC)组(n=37)进行比较。符合正态分布的连续性变量采用独立样本t检验进行分析,偏态分布的连续性变量采用秩和检验进行分析,分类变量采用Pearsonχ2检验进行分析,评分系统与机械性并发症之间的相互关系采用Logistic回归分析加以讨论。结果NMC组Roussouly 1型明显多于MC组(P=0.048),而Roussouly 4型明显少于MC组(P=0.039)。NMC组符合理想LA的患者数量明显多于MC组(P<0.001)。术后影像学参数以及临床评分较术前有明显改善(P<0.001)。Logistic回归分析结果显示:符合理想LA与机械性并发症发生率(P<0.001)、内固定相关并发症发生率(P<0.001)、内固定松动发生率(P=0.002)呈负相关。结论在手术过程中调整ADS患者的LA十分重要。Roussouly分型无法准确预测ADS长节段内固定矫形术后机械性并发症的发生风险。

Objective To evaluate Roussouly classification for its accuracy in predicting mechanical complications after long-segment internal fixation in the treatment of adult degenerative scoliosis (ADS).Methods This study retrospectively analyzed ADS patients who received long-segment internal fixation between December 2016 and October 2018.The radiographic parameters included coronal Cobb’s angle (CA),pelvic incidence (PI),pelvic tilt (PT),sacral slope (SS),thoracic kyphosis (TK),lumbar lordosis (LL),sagittal vertical axis (SVA),the number of vertebrae included in the lordosis (NVL),the lumbar sagittal apex (LA),inflexion point (IP) between thoracic kyphosis and lumbar lordosis,distribution index (LDI).The patients were divided into a mechanical complication (MC) group and no mechanical complication (NMC) group based mechanical complications.The continuous variables conforming to normal distribution were analyzed by independent sample t test.The continuous variables of skewness distribution were analyzed by rank sum test.The classification variables were analyzed by Pearson Chi-square test.Logistic regression analysis was used to discuss the relationship between the evaluation system and mechanical complications.P < 0.05 was considered statistically significant.Results A total of 71 ADS patients(34 patients in MC group and 37 patients in NMC group) were included in this study.The number of Roussouly-type 1 in NMC group was significantly more than that in MC group (P=0.048),while the Roussouly-type 4 was significantly less than that in MC group (P=0.039).The number of patients with ideal LA in NMC group was significantly higher than that in MC group (P < 0.001).Postoperative radiographic parameters and clinical scores were significantly improved after surgery (P < 0.001).Logistic regression analysis showed that matching ideal LA was negatively correlated with the occurrence of mechanical complication (P < 0.001),fixation-related complication(P < 0.001) and internal fixation loosening (P=0.002).Conclusions It is very important to adjust LA in ADS patients during surgery.Roussouly classification will not accurately predict the risk of mechanical complication after long-segment fixation in the treatment of ADS.