作　　者： ; ; ; ;

机构地区： 广州中医药大学

出　　处： 《中国中医骨伤科杂志》 2019年第2期17-20,共4页

摘　　要： 目的:探讨腰椎后路内固定术后邻近节段退变与脊柱-骨盆矢状位参数的相关性。方法:自2010年1月至2014年12月,纳入符合标准的因退变性疾病行腰椎后路内固定术患者84例:男40例,女44例;年龄36～85岁,平均(63.6±8.9)岁。采用疼痛视觉模拟评分(VAS)及日本骨科协会评估治疗分数(JOA)评估手术疗效,分别测量手术邻近节段的椎间隙高度及腰椎活动度了解退变情况,并测量腰椎前凸角(LL)、骨盆入射角(PI)、术前骨盆入射角与腰椎前凸角差值(△PILL)。对上述脊柱-骨盆矢状位参数与术后邻近节段退变发生率进行相关性分析。结果:平均随访46.2个月,共有34例患者邻近节段发生影像学退变,发生率为40.48%.其中术后邻近节段退变组与无退变组的LL在手术前后分别比较,差异均无统计学意义(P>0.05);而术后邻近节段退变组的术前PI,术前△PILL均大于无退变组,差异有统计学意义(P<0.05);术前PI,术前△PILL与术后邻近节段退变呈显著正相关(r=0.572,r=0.738)。结论:脊柱-骨盆矢状位参数与腰椎后路内固定术后邻近节段退变的发生密切相关,术前PI及△PILL越大的患者,术后更易于发生邻近节段退变。 Objective:To investigate the correlationship between adjacent segment degeneration and spinopelvic sagittal parameters after posterior lumbar internal fixation.Methods:84 patients(40males,44 females,aged 36~85 years,average(63.6±8.9)years)who met the inclusion criteria from January 2010 to December 2014 were enrolled.The visual analogue scale(VAS)and Japanese orthopaedic association(JOA)scores were used to evaluate the efficacy of surgical treatment.The height of the intervertebral space and the range of motion(ROM)of adjacent segments were measured to access the degeneration status of lumbar spine.The lumbar lordosis(LL),pelvic incidence(PI),and preoperative △PILL(△PILL=PI-LL)were measured.Then analyze the correlationship between the spinopelvic sagittal parameters and incidence of postoperative adjacent segment degeneration.Results:1)After an average follow-up of 46.2months,a total of 34 patients developed adjacent segment degeneration(ASDeg),with an incidence of 40.48%.2)There was no significant difference in the LL between the ASDeg group and the non-ASDeg group either before or after surgery(P>0.05).3)The preoperative PI and preoperative △PILL were larger in the ASDeg group than that in the non-ASDeg group,and the difference was statistically significant(P<0.05).4)There was a significant positive correlation between preoperative PI and preoperative△PILL and postoperative adjacent segment degeneration(r=0.572,r=0.738).Conclusion:The spinopelvic sagittal parameters are closely related to the occurrence of adjacent segment degeneration after posterior lumbar interbody fusion.Patients with large preoperative PI and preoperative△PILL were more likely to develop adjacent segment degeneration after surgery.

关 键 词： 腰椎后路内固定术 邻近节段退变 脊柱 骨盆矢状位参数 相关性

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