腰椎椎间盘突出症椎间盘切除术后脊柱-骨盆矢状面形态的自然转归

Spontaneous outcome of spinal-pelvic sagittal morphology after discectomy for lumbar disc herniation

目的 探讨椎间盘切除术对腰椎椎间盘突出症(LDH)患者脊柱-骨盆矢状面形态的影响。方法 回顾性分析2016年4月—2022年4月采用椎间盘切除术治疗的172例LDH患者资料(LDH组),并选取同期50名健康志愿者作为对照组,测量并比较站立位全脊柱侧位X线片上矢状面平衡(SVA)、胸椎后凸(TK)、胸腰椎交界角(TLJA)、腰椎前凸(LL)、腰骶前凸(LSL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)等参数,采用健康调查简表(SF-36)评分评估临床疗效。结果 LDH组患者术前SVA、TK、PT明显高于对照组,LL、PI、SS明显低于对照组,差异均有统计学意义(P < 0.05)。LDH组患者术后6个月SVA、TK、LL、PI、SS较术前改善,差异均有统计学意义(P < 0.05)。LDH组患者术后6个月各脊柱-骨盆矢状面参数与对照组相比,差异均无统计学意义(P > 0.05)。LDH组所有患者术后腰痛及下肢神经损伤症状均明显改善,其中123例手术前后采用SF-36评分完成了临床疗效评价,术后6个月生理功能、躯体疼痛、一般健康状况、社会功能4个维度的评分明显优于术前,差异均有统计学意义(P < 0.05)。结论 LDH患者单纯椎间盘切除术后脊柱-骨盆矢状面形态有自发改善趋势,表现为SVA、TK、LL、PI、SS的改善。

Objective To investigatetheeffect of discectomy on thespinal-pelvic sagital morphology in patientswithlumbar disc herniation(LDH).Methods From April 2016 to April 2022,the data of 172 LDH patients treated with discectomy(LDH group)were retrospectively analyzed,and 50 healthy volunteers were selected as the control group.Sagittal vertical axis(SVA),thoracic kyphosis(TK),thoracolumbar junctional angle(TLJA),lumbar lordosis(LL),lumbosacral lordosis(LSL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)were measured and compared on standing lateral whole spine roentgenograph.The clinical efficacy was evaluated by the MOS 36-item short-form health survey(SF-36).Results Preoperative SVA,TK and PT in LDH group were significantly higher than those in the control group,while LL,PI and SS were significantly lower than those in the control group,and all with a statistical significance(P<0.05).SVA,TK,LL,PI and SS in LDH group were significantly improved at postoperative 6 months,with statistical significances(P<0.05).There was no significant difference in spinal-pelvic sagittal plane parametersat postoperative 6 months between LDH group and the control group(P>0.05).Postoperative symptoms of low back pain and lower limb nerve damage were significantly improved in all the patients in LDH group.Among them,123 patients completed SF-36 before and after surgery,and the scores of physiological function,body pain,general health and social function at postoperative 6 months were significantly better than those before surgery,and the differences were statistically significant(P<0.05).Conclusion The spinal-pelvic sagital morphology of LDH patients improved spontaneously after simple discectomy,manifested as improvements in SVA,TK,LL,PI,and SS.