陈旧性创伤性脊柱后凸畸形术前站立位至俯卧位脊柱-骨盆矢状位参数变化研究

Preoperative standing to prone spinal-pelvic sagittal parameter changes in old traumatic spinal fractures with kyphosis

目的探究陈旧性创伤性脊柱后凸畸形术前站立位至俯卧位脊柱-骨盆矢状位参数的变化。方法回顾分析2016年12月—2021年6月收治的36例手术治疗陈旧性创伤性脊柱后凸畸形患者临床资料。其中男7例,女29例;年龄50~79岁,平均63.9岁。病变节段:T112例,T1212例,T11、122例,T12、L14例,L112例,L22例,L2、31例,L31例。病程4~120个月,平均19.6个月。手术采用Smith-Petersen截骨4例,Ponte截骨6例,经椎弓根椎体截骨2例,改良的四级截骨18例。骨密度−3.0~0.5 T,平均−1.62 T。测量术前站立位与俯卧位脊柱-骨盆矢状位参数,包括局部后凸Cobb角(local kyphosis Cobb angle,LKCA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slop,SS)、骨盆倾斜角(pelvic tilt,PT)、PI与LL匹配度(PI and LL mismatch,PI-LL)。按照以下公式计算后凸柔韧度,后凸柔韧度=(术前站立位LKCA−术前俯卧位LKCA)/术前站立位LKCA×100%。比较术前站立位和俯卧位脊柱-骨盆矢状位参数变化,并采用Pearson相关分析判断术前站立位和俯卧位各参数之间的相关性。结果当体位由站立位变为俯卧位后,LKCA与TK均显著减小,差异有统计学意义(P<0.05);SS、LL、PT及PI-LL差异无统计学意义(P>0.05)。Pearson相关分析示,无论站立位还是俯卧位,LL与SS和PI-LL均具有相关性(P<0.05),并且在俯卧位时LL与SS正相关强度较站立位时有所增加。在站立位时,LKCA与SS和PT均存在相关性(P<0.05);而当体位变为俯卧位后,LKCA与SS和PT之间的相关性消失,而PT与PI-LL之间成正相关(P<0.05)。患者后凸柔韧度为25.13%~78.79%,平均33.85%。结论陈旧性创伤性脊柱后凸畸形患者术前从站立位到俯卧位时,LKCA、TK均显著减小,脊柱-骨盆矢状位参数的相关性也有所变化,术前手术方案的制定应考虑到这些变化。

Objective To investigate the changes in spinal-pelvic sagittal parameters from preoperative standing to prone position in old traumatic spinal fractures with kyphosis.Methods The clinical data of 36 patients admitted between December 2016 and June 2021 for surgical treatment of old traumatic spinal fractures with kyphosis,including 7 males and 29 females,aged from 50 to 79 years(mean,63.9 years),were retrospectively analyzed.Lesion segments included 2 cases of T11,12 cases of T12,2 cases of T11,12,4 cases of T12 and L1,12 cases of L1,2 cases of L2,1 case of L2,3,and 1 case of L3.The disease duration ranged from 4 to 120 months,with an average of 19.6 months.Surgical procedures included Smith-Petersen osteotomy in 4 cases,Ponte osteotomy in 6 cases,pedicle subtraction osteotomy in 2 cases,and improved fourth level osteotomy in 18 cases;the remaining 6 cases were not osteotomized.The bone mineral density ranged from−3.0 to 0.5 T,with a mean of−1.62 T.The spinal-pelvic sagittal parameters from preoperative standing to prone positions were measured,including local kyphosis Cobb angle(LKCA),thoracic kyphosis(TK),lumbar lordosis(LL),sacral slope(SS),pelvic tilt(PT),and PI and LL mismatch(PI-LL).The kyphotic flexibility=(preoperative standing LKCA−preoperative prone LKCA)/preoperative standing LKCA×100%.Spinal-pelvic sagittal parameters were compared between standing position and prone position before operation,and Pearson correlation was used to judge the correlation between the parameters of standing position and prone position before operation.Results When the position changed from standing to prone,LKCA and TK decreased significantly(P<0.05),while SS,LL,PT,and PI-LL had no significant difference(P>0.05).Pearson correlation analysis showed that LL was significantly correlated with SS and PI-LL in both standing and prone positions(P<0.05),and the correlation strength between LL and SS in prone position was higher than that in standing position.In the standing position,LKCA was significantly correlated with SS and PT(P<0.05).However,when the position changed from standing to prone,the correlation between LKCA and SS and PT disappeared,while PT and PI-LL was positive correlation(P<0.05).The kyphotic flexibility was 25.13%-78.79%,with an average of 33.85%.Conclusion For the patients of old traumatic spinal fractures with kyphosis,the preoperative LKCA and TK decrease significantly from standing position to prone position,and the correlation between spinal and pelvic parameters also changed,which should be taken into account in the formulation of preoperative surgical plan.