| 脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及对手术疗效的评估价值 |
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投稿时间：2022-01-21
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| 作者 | Author | 单位 | Address | E-Mail |
| 张文洪 |
ZHANG Wen-hong |
江阴市中医院院部影像科, 江苏 江阴 214400 |
Hospital Department of Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China |
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| 於洋 |
YU Yang |
江阴市中医院医学影像科, 江苏 江阴 214400 |
Department of Medical Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China |
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| 李宏 |
LI Hong |
江阴市中医院医学影像科, 江苏 江阴 214400 |
Department of Medical Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China |
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| 刘芳 |
LIU Fang |
江阴市中医院医学影像科, 江苏 江阴 214400 |
Department of Medical Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China |
lbxg3948@21cn.com |
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| 期刊信息：《中国骨伤》2023年，第36卷，第9期，第827-832页 |
| DOI：10.12200/j.issn.1003-0034.2023.09.007 |
| 基金项目:江苏省优势学科建设工程项目(编号:YSHL0814-25) |
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中文摘要:
目的：探究脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及评估手术疗效的价值。
方法：回顾性分析2019年10月至2020年10月采用后路腰椎椎体间融合术治疗的95例双节段腰椎滑脱患者,其中男31例,女64例;年龄41~63(52.10±4.35)岁;病变程度,Ⅰ度47例,Ⅱ度48例。术后3个月根据Oswestry功能障碍指数(Oswestry dysfunction index,ODI)改善率评定手术疗效,ODI改善率 ≥ 50%为良好,<50%为不良。95例根据手术疗效分为疗效良好组(74例)和疗效不良组(21例)。比较两组患者的临床资料,包括性别、年龄、身体质量指数、病程、病变程度、手术时间、术中出血量、合并症;观察术前及术后3个月脊柱-骨盆矢状面参数,包括脊柱骶骨角(spino-sacral angle,SSA),T1骨盆角(T1 pelvic angle,TPA),腰椎前凸角(lumbar lordosis,LL),骨盆投射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),骶骨倾斜角(sacral slope,SS);采用视觉模拟评分法(visual analogue scale,VAS)和ODI对临床症状进行评定;并分析手术前后脊柱-骨盆矢状面参数变化值与VAS、ODI变化值的相关性,评价术后3个月脊柱-骨盆矢状面参数评估双节段腰椎滑脱症患者手术疗效的价值。
结果：疗效不良组病程、手术时间长于疗效良好组,病变程度高于疗效良好组(P<0.05);疗效良好组术前、术后3个月SSA、TPA、LL、SS均高于疗效不良组,PT低于疗效不良组(P<0.05);疗效良好组手术前后SSA、TPA、LL、PT、SS变化值均大于疗效不良组(P<0.05)。两组术后3个月VAS、ODI均低于术前,且疗效良好组低于疗效不良组(P<0.05);疗效良好组手术前后VAS、ODI变化值均大于疗效不良组(P<0.05)。手术前后SSA、TPA、LL、PT、SS变化值与VAS、ODI变化值呈正相关(P<0.05);术后3个月SSA、TPA、LL、PT、SS评估双节段腰椎滑脱症患者手术疗效为不良的获取曲线下面积(area under the curve,AUC)分别为0.868、0.797、0.875、0.822、0.853,各指标联合评估的AUC最大,为0.927,最佳评估敏感度、特异度分别为90.50%、91.89%。
结论：双节段腰椎滑脱症患者手术前后脊柱-骨盆矢状面参数SSA、TPA、LL、SS呈升高趋势,PT呈降低趋势,PI无明显变化,且SSA、TPA、LL、SS、PT变化值与患者疼痛程度、腰椎功能改善情况密切相关,可作为评估手术疗效的参数。 |
| 【关键词】双节段腰椎滑脱症 后路腰椎椎体间融合术 脊柱-骨盆矢状面参数 疼痛 腰椎功能 |
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| The trend of changes in spine-pelvic sagittal parameters before and after surgery in patients with double-segment lumbar spondylolisthesis and their evaluating for surgery efficacy |
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ABSTRACT
Objective To explore the trend of changes in the parameters of the spine-pelvic sagittal plane before and after surgery in patients with double-segment lumbar spondylolisthesis (LSL) and to evaluate the value of the surgical effect.
Methods A retrospective analysis of 95 double-segment lumbar spondylolisthesis patients treated with posterior lumbar interbody fusion from October 2019 to October 2020 were analyzed,including 31 males and 64 females;age ranging from 41 to 63 years old,with an average of (52.10±4.35) years old;degree of lesion,47 patients with gradeⅠand 48 patients with gradeⅡ. The surgical efficacy was evaluated according to the Oswestry dysfunction index(ODI) improvement rate at 3 months after operation. ODI improvement rate ≥ 50% was considered good,and <50% was considered bad. Ninety-five patients were divided into good curative effect group (74 cases) and poor curative effect group (21 cases) according to surgical curative effect. The clinical data,such as gender,age,body mass index,course of disease,degree of disease,operation time,intraoperative blood loss, and comorbidities were compared between two groups were compared. The parameters of spine pelvis sagittal plane were observed before and 3 months after operation,including spine sacral angle (SSA),T1 pelvic angle (TPA),lumbar lordosis (LL),pelvic incidence (PI),pelvic tilt (PT),sacral slope (SS). Clinical symptoms were evaluated using visual analogue scale (VAS) and ODI. The correlation between the changes of spine pelvis sagittal plane parameters and the changes of VAS and ODI before and after surgery were analyzed,and the value of spine pelvis sagittal plane parameters in evaluating the surgical efficacy of patients with double level lumbar spondylolisthesis at 3 months after surgery was evaluated.
Results The courses of disease and surgical time in the group with poor efficacy were longer than those in the group with good efficacy,and the degree of lesion was higher in the group with poor efficacy (P<0.05). The SSA,TPA,LL,and SS of the group with good efficacy were higher than those of the group with poor efficacy before and 3 months after surgery,while the PT was lower than that of the group with poor efficacy (P<0.05). The changes in SSA,TPA,LL,PT,and SS before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (P<0.05). The VAS and ODI of both groups were lower at 3 months after surgery than before,and the group with good efficacy was lower(P<0.05). The changes in VAS and ODI before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (P<0.05). The changes in SSA,TPA,LL,PT,SS before and after surgery were positively correlated with the changes in VAS and ODI (P<0.05). Three months after surgery,SSA,TPA,LL,PT,and SS were used to evaluate the surgical efficacy of patients with dual level lumbar spondylolisthesis. The area under the curve (AUC) was 0.868,0.797,0.875,0.822,and 0.853,respectively. The combined evaluation of all indicators resulted in the highest AUC,0.927,and the best sensitivity and specificity were 90.50% and 91.89%,respectively.
Conclusion The spine pelvis sagittal plane parameters SSA,TPA,LL,and SS of patients with double level lumbar spondylolisthesis before and after surgery show an upward trend;PT shows a downward trend;PI do not change significantly. And the changes of SSA,TPA,LL,SS,and PT are closely related to the patient's pain level and the improvement of lumbar function,which can be used as parameters to evaluate the surgical efficacy. |
| KEY WORDS Two-segment lumbar spondylolisthesis Posterior lumbar interbody fusion Spine-pelvic sagittal parameters Pain Lumbar spine function |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张文洪,於洋,李宏,刘芳.脊柱-骨盆矢状面参数在双节段腰椎滑脱症患者手术前后的变化趋势及对手术疗效的评估价值[J].中国骨伤,2023,36(9):827~832 |
| 英文格式: | ZHANG Wen-hong,YU Yang,LI Hong,LIU Fang.The trend of changes in spine-pelvic sagittal parameters before and after surgery in patients with double-segment lumbar spondylolisthesis and their evaluating for surgery efficacy[J].zhongguo gu shang / China J Orthop Trauma ,2023,36(9):827~832 |
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