脊柱矢状位平衡对PVP术后患者功能恢复的影响

发布时间：2018-03-15 05:28

本文选题：矢状位　切入点：平衡　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的引起脊柱-骨盆矢状位失衡的原因有很多种,其中包括骨质疏松症为基础所致的椎体压缩性骨折(致胸、腰椎段骨折)等,严重的脊柱-骨盆结构损坏会破坏脊柱-骨盆矢状位平衡,对于由以上原因所致的脊柱-骨盆矢状位失衡,经皮椎体成形术(percutaneous vertebroplasty,PVP)来重新建立椎体的各面之间的平衡,特别是矢状位上的平衡关系,目前在临床上应用比较广泛,本研究通过比较PVP手术前后患者脊柱-骨盆矢状位平衡参数及相关量表数值的差异,探讨脊柱矢状位平衡重建对PVP术后患者功能恢复的影响。方法运用回顾性对照的方法分析皖南医学院第一附属医院脊柱骨科2014年04月~2015年11月所选取的52个病例(男性12人,女性40人,平均年龄为68.25岁,年龄范围58岁~85岁)PVP手术前后患者颈椎前凸角(CL)、胸椎后凸角(TK)、腰椎前凸角(LL)、脊柱矢状位平衡(SVA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)、下腰痛JOA评分、Oswestry腰背下肢功能障碍评分、VAS疼痛评分等指标的变化差异,52个病例中,胸段骨折21人,腰段骨折31人。结果52例患者手术均顺利完成,无手术或围手术期死亡病例出现,术后随访时间1~6个月,平均时间4.5个月。术前CL9.212°±30.499°、TK41.385°±27.957°、LL59.135°±36.367°、SVA20.692mm±85.861mm、PI71.614°±35.303°、PT30.635°±19.811°、SS54.700°±31.944°、JOA评分8.385±2.162、Oswestry评分34.808±3.042、VAS评分6.808±0.971。术后CL9.077°±16.384°、TK24.635°±13.233°、LL42.865°±8.765°、SVA-20.962mm±47.397mm、PI38.173°±7.326°、PT14.000°±3.492°、SS34.519°±5.497°、JOA评分24.058±2.118、Oswestry评分12.539±1.787、VAS评分1.712±0.696。脊柱—骨盆矢状位参数指标CL值在手术前后比较,其差异无统计学意义(P0.05);术后TK、LL、SVA、PI、PT、SS等测量参数与术前比较,差异均有统计学意义(P0.05);VAS评分、JOA评分、ODI评分与术前比较,差异有统计学意义(P0.05);CL与PI及PT之间密切相关(P0.01,CL与PI比较;P0.05,CL与PT比较);TK与PT之间密切相关(P0.01);PI与PT之间密切相关(P0.01)。结论脊柱的平衡包括水平面上、冠状面上的以及矢状位上的平衡,由于人类脊柱生理弯曲的存在,使得脊柱矢状位平衡在维持人体正常姿势中起到极为重要的作用;脊柱-骨盆系统作为一个整体,任何一方的结构损伤及破坏都会引起相关联的一系列脊柱矢状位参数的改变,各参数之间关系密切;因各种原因导致的脊柱-骨盆矢状位失衡,采用经皮椎体成形术重建脊柱-骨盆的平衡可以取得良好的临床疗效,不仅表现为相关参数的恢复正常或接近正常,也表现为相关评估量表的改善;PVP术后患者脊柱-骨盆矢状位参数的重建对患者术后恢复及生活质量的改善有重要的促进作用,临床医生应当更加重视脊柱-骨盆矢状位参数评价体系在临床上应用。
[Abstract]:Objective there are many causes of spinal and pelvic sagittal imbalance, including vertebral compression fractures (thoracolumbar fractures) based on osteoporosis. Severe structural damage to the spine and pelvis can destroy the sagittal balance of the spine and pelvis, and for the spinal and pelvic sagittal imbalance caused by the above reasons, percutaneous vertebroplasty (PVP) is used to re-establish the balance between the different sides of the vertebra. Especially the balance relationship in sagittal position is widely used in clinic at present. The purpose of this study was to compare the spinal and pelvic sagittal balance parameters and relevant scale values before and after PVP operation. To investigate the effect of sagittal balance reconstruction on the functional recovery of patients after PVP methods 52 cases (12 males) from April 2014 to November 2015 in Department of Spinal Orthopaedics, first affiliated Hospital of Southern Anhui Medical College, were analyzed retrospectively. 40 women, with an average age of 68.25 years, Age range 58 years and 85 years before and after PVP operation in patients with anterior cervical kyphoid angle, thoracic kyphoid angle TKN, lumbar spine anterior kyphoid angle, spinal sagittal balance sagittal balance, pelvic angle of incidence, pelvic obliquity angle, sacral obliquity angle, JOA score of lower back pain, and Oswestry loin and lower extremity score. The changes of VAS pain score were different in 52 cases. Results all the 52 patients were successfully operated, no operative or perioperative death occurred, and the follow-up time was 1 ~ 6 months. The mean time was 4.5 months. Preoperative CL9.212 掳卤30.499 掳TK41.385 掳卤27.957 掳LL59.135 掳卤36.367 掳SVA20.692mm 卤85.861mm PI71.614 掳卤35.303 掳PT30.635 掳卤19.811 掳SS54.700 掳卤31.944 掳JOA score 8.385 卤2.162Oswestry score 34.808 卤3.042VAS 6.808 卤0.971.The postoperative CL9.077 掳卤16.384 掳TK24.635 掳卤13.233 掳LL42.865 掳卤8.765 掳SVA-20.96mm 卤47.739mm P38.173 卤7.326 掳TOA score before and after operation were compared with the score of 34.808 卤3.042VAS (6.808 卤0.971L) and the postoperative CL9.077 掳卤16.384 掳TK24.635 掳卤13.233 掳LL42.865 掳卤8.765 掳SVA-20.96mm 卤47.739mm 卤47.39mm P38.173 卤7.326 掳TOA score before and after operation. There was no significant difference between the two groups (P 0.05), and there was no significant difference in the parameters of postoperative TKL, SVA, Pi, PTSS and before operation, the difference was statistically significant (P 0.05 VAS score, JOA score, ODI score and preoperative comparison), and there was no significant difference between before and after operation. There was a significant correlation between P0.05, Pi and PT. Conclusion the balance of spine includes horizontal balance, coronal balance and sagittal balance. Due to the existence of physiological curvature of the human spine, the sagittal balance of the spine plays an extremely important role in maintaining the normal posture of the human body. Structural damage and destruction on either side will result in a series of related changes in the sagittal position parameters of the spine, which are closely related to each other. Using percutaneous vertebroplasty to reconstruct the balance of spine and pelvis can obtain good clinical effect, not only for the related parameters to return to normal or close to normal. It also showed that the improvement of correlative assessment scale and the reconstruction of the sagittal position parameters of spine and pelvis after PVP had an important role in promoting the recovery and the improvement of quality of life after PVP. Clinicians should pay more attention to the clinical application of spinal-pelvic sagittal parameter evaluation system.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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