摘要
目的探索多节段退变性腰椎管狭窄症腰骶椎融合术后脊柱骨盆参数变化及其临床疗效。方法2018年6月至2020年6月,共85例多节段退变性腰椎管狭窄症患者经腰骶椎体间融合手术,随访(24.00±2.18)个月,根据术前及末次随访SVA(sagittal vertical axis,SVA)≤50 mm分为平衡组,SVA>50 mm分为非平衡组,测量术前及末次随访脊柱骨盆相关参数,并进行ODI(OSWESTRY disability index)与SF-36(the MOS item short from health survey,SF-36)评分,在末次随访时根据改良MacNab标准评定疗效,统计学分析脊柱骨盆参数变化及其临床疗效。结果在术前分组中,非平衡组SVA术前术后比较明显改善(P<0.01),平衡组术前术后变化差异无统计学意义;两组术后ODI、SF-36评分均较术前改善(P<0.01),两组之间差异无统计学意义(P>0.05)。在术后分组中,两组之间ODI、SF-36评分差异有统计学意义(P<0.01),平衡组优于非平衡组;两组之间△LL(lumbar lordosis,LL)与△HOD/n(height of disc,HOD)差异有统计学意义(P<0.01),平衡组HOD、LL增加明显。根据改良MacNab标准评定:优50例,良22例,可7例,差6例,优良率84.7%(72/85)。结论多节段退变性腰椎管狭窄症减压融合手术疗效满意,恢复椎间盘高度以增加LL从而改善矢状面平衡,能够提高患者术后疗效。
Objective To investigate the changes of spinal and pelvic parameters after multi-level lumbosacral fusion in patients with degenerative lumbar spinal stenosis.Methods From June 2018 to June 2020,a total of 85 patients with multil-level degenerative lumbar spinal stenosis underwent lumbosacral interbody fusion,and were followed for(24±2.18)months,divided into balanced groups based on preoperative and last follow-up SVA(sagittal vertical axis,SVA)50 mm.SVA>50 mm was classified as unbalanced group.Preoperative and last follow-up spino-pelvic parameters were measured,and the OSWESTRY disability index(ODI)and SF-36(the MOS item short from health survey,SF-36)scores were performed.The overall curative effect was evaluated according to the modified MacNab criteria at the last follow-up,and the changes of spinal and pelvic parameters and the clinical curative effect were statistically analyzed.Results In the preoperative group,the SVA of the unbalanced group was significantly improved before and after operation(P<0.01),while there was no significant difference in the preoperative and postoperative changes of the balanced group.The ODI and SF-36 scores of both groups were improved after operation compared with those before operation(P<0.01),and there was no significant difference between the two groups.In the postoperative group,there were statistically significant differences in ODI and SF-36scores between the two groups(P<0.01),and the balance group was better than the unbalanced group.There were statistical differences in△LL and△HOD/n(height of disc,HOD)of the lumbar department between the two groups(P<0.01).In 85 cases,△LL was positively correlated with△HOD/n(r=0.73).According to the modified MacNab standard,50 cases were excellent,22 cases were good,7 cases were fair,6 cases were poor,with an excellent and good rate was 84.7%(72/85).Conclusion Decompression and fusion surgery is effective for multi-level degenerative lumbar spinal stenosis.Patients′postoperative outcomes can be improved by restoring the height of the intervertebral disc to increase LL and improve sagittal balance.
作者
王晓陆
尹宗生
刘艺明
马力
郁贤舜
WANG Xiaolu;YIN Zongsheng;LIU Yiming;MA Li;YU Xianshun(Department of Orthopaedic,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Spinal Surgery,Hefei First People′s Hospital,Hefei 230031,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2023年第2期224-229,共6页
The Journal of Practical Medicine
基金
国家自然科学基金项目(编号:81871785)。
关键词
退变性腰椎管狭窄症
腰骶椎体间融合
多节段
脊柱骨盆参数
临床疗效
lumbosacral diseases of the lumbar spine
lumbosacral interbody fusion
multiple segment
spinal and pelvic parameters
health-related quality of life
