退变性腰椎侧凸矫形术后即刻冠状位平衡发生再失衡的危险因素分析

Risk factors on re-imbalance of immediate postoperative coronal balance after corrective surgery for degenerative lumbar scoliosis

目的:探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)矫形术后即刻冠状位平衡患者末次随访时发生失衡的危险因素.方法:回顾性分析我院骨科2010年1月~2020年12月间DLS患者共156例.纳入术后即刻(3个月内)冠状位平衡患者,记录患者年龄、性别、术前冠状位平衡状态、L5横突与骶骨融合状态、顶椎位置、顶椎偏距(apical vertebra translation,AVT)值、主弯Cobb角及腰骶弯Cobb角、术前L4倾斜方向和倾斜角度、术后即刻主弯Cobb角及腰骶弯Cobb角、术后即刻L4倾斜方向和倾斜角度、术后即刻近端固定椎(up-per instrumented vertebra,UIV)倾斜方向和倾斜角度、术后即刻T1-UIV Cobb角等情况.根据末次随访冠状位平衡状态分为末次随访冠状位平衡组与末次随访冠状位失衡组.分析上述因素与末次随访时冠状位失衡的相关性.结果:共纳入94例DLS术后即刻冠状位平衡状态患者,其中15例男性,79例女性,年龄63.10±6.47岁,随访32.5±26.9个月.术后即刻冠状位平衡患者末次随访时冠状位仍处于平衡状态者73例(77.7%),末次随访冠状位失衡患者21例(22.3%).两组间术前AVT值、术前主弯Cobb角、术后即刻主弯Cobb角、术前L4倾斜角、术后即刻L4倾斜角、术后即刻UIV倾斜角具有显著统计学差异(P<0.05).多因素回归分析发现术前AVT值(P=0.043)、术前主弯Cobb角(P=0.018)、术后即刻UIV倾斜角(P=0.035)与术后即刻冠状位平衡患者出现末次随访时冠状位失衡具有独立相关性.结论:DLS矫形术后即刻冠状位平衡患者术前AVT值、术前主弯Cobb角和术后即刻UIV倾斜角越大,末次随访越容易出现冠状位失平衡变化.

Objectives:To explore the potential risk factors of final follow-up coronal imbalance in degenera-tive lumbar scoliosis(DLS)patients with immediate postoperative coronal balance after correction surgery.Methods:A retrospective analysis of 156 DLS patients treated at the Department of Orthopedics,Peking U-niversity Third Hospital between January 2010 and December 2020 was conducted.And 94 patients with im-mediate postoperative coronal balance(within 3 months)were included in the study.Parameters such as age,gender,preoperative coronal balance,fusion of L5 transverse process and S1,location of apical vertebra,api-cal vertebra translation(AVT),Cobb angles of main curve and lumbar sacral curve,and tilt direction and an-gle of L4;and immediate postoperative Cobb angles of main curve and lumbar sacral curve,tilt direction and angle of L4,tilt direction and angle of upper instrumented vertebra(UIV),and Cobb angle of T1-UIV were recorded.The patients were divided into final follow-up coronal balance group and final follow-up coronal imbalance group.The corelations between the previous parameters and coronal imbalance at final follow-up were analyzed.Results:A total of 94 DLS patients,including 15 males and 79 females,with an average age of 63.10±6.47 years were under immediate postoperative coronal balance status,and the follow-up duration was 32.5±26.9 months.73 patients(77.7%)were of the final follow-up coronal balance group and the remain ing 21(22.3%)were of the final follow-up coronal imbalance group.Comparison between the two groups showed statistically significant differences(P<0.05)in preoperative AVT,preoperative Cobb angle,immediate postoperative Cobb angle of main curve,preoperative and immediate postoperative tilt angles of L4,and immediate postoperative tilt angle of UIV.Multivariate Logistic regression analysis showed that preoperative AVT(P=0.043),preoperative Cobb angle of main curve(P=0.018),immediate postoperative tilt angle of UIV(P=0.035)were independently associated with follow-up coronal imbalance for immediate postoperative coronal balance patients.Conclusions:Immediate postoperative coronal balance patients with greater preoperative AVT,preoperative Cobb angle of main curve,and immediate postoperative tilt angle of UIV were more likely to develop final follow-up coronal imbalance.