经椎弓根截骨螺钉固定修复胸腰椎后凸畸形:脊柱-骨盆参数的相关性分析

发布时间：2019-01-10 14:03

【摘要】：背景:退变性胸腰椎后凸畸形患者因矢状面失平衡导致腰痛,进而严重影响其生活质量,截骨矫形重建此类患者的矢状面尤为重要。目的:探讨经椎弓根椎体截骨矫形螺钉置入内固定修复退变性胸腰椎后凸畸形患者术后生活质量与脊柱-骨盆参数变化的关系及临床意义。方法:回顾性分析2010年5月至2014年10月在河北省沧州中西医结合医院行L2经椎弓根椎体截骨矫形螺钉置入内固定的59例退变性胸腰椎后凸畸形患者的临床资料。所有患者手术前后均摄站立位全脊柱正侧位X射线片。统计测量所有患者术前、术后X射线平片的胸椎后凸角、腰椎前凸角、T1骨盆角、矢状面平衡、骨盆投射角、骶骨倾斜角和骨盆倾斜角;术前术后运用SF-36量表评估患者的生活质量并进行对比。结果与结论:(1)脊柱-骨盆相关参数中,除骨盆投射角外,其余参数手术前后相比差异均有显著性意义(P0.01);就SF-36量表各维度而言,术后评分均高于术前(P0.01);(2)腰椎前凸角的变化与骨盆倾斜角、骶骨倾斜角、矢状面平衡存在线性相关,骨盆倾斜角的变化与骶骨倾斜角、身体疼痛维度及总体健康状况维度存在线性相关,矢状面平衡的变化与腰椎前凸角、身体疼痛、总体健康状况存在相关性,T1骨盆角的变化与腰椎前凸角、矢状面平衡、身体疼痛及总体健康状况也存在相关性;(3)结果表明,经椎弓根椎体截骨螺钉置入内固定能够有效重建退变性胸腰椎后凸畸形患者的脊柱-骨盆矢状面形态,缓解疼痛,显著改善患者的生活质量。
[Abstract]:Background: the patients with degenerative thoracolumbar kyphosis are suffering from low back pain due to sagittal imbalance, which can seriously affect their quality of life. It is particularly important to reconstruct sagittal plane of degenerative thoracolumbar kyphosis patients by osteotomy. Objective: to investigate the relationship between the quality of life (QOL) and the changes of spine-pelvis parameters in degenerative thoracolumbar kyphosis patients with transpedicular osteotomy and internal fixation. Methods: the clinical data of 59 patients with degenerative thoracolumbar kyphosis who were treated with L2 pedicle osteotomy and orthopedic screws from May 2010 to October 2014 in Cangzhou Integrated Chinese and Western Medicine Hospital of Hebei Province were analyzed retrospectively. All patients were taken the standing position of the whole spine X-ray before and after operation. The thoracic kyphosis angle, lumbar kyphosis angle, T1 pelvic angle, sagittal balance, pelvic projection angle, sacral obliquity angle and pelvic obliquity angle were measured statistically. The quality of life (QOL) was evaluated with SF-36 scale before and after operation. Results and conclusion: (1) except pelvis projection angle, there were significant differences between the other parameters before and after operation (P0.01). As far as each dimension of SF-36 scale was concerned, the postoperative score was higher than that before operation (P0.01). (2) the changes of lumbar lordosis angle were linearly correlated with the obliquity of the pelvis, the angle of the sacrum, the balance of the sagittal plane, and the change of the obliquity of the pelvis with the angle of the sacrum, the dimension of body pain and the dimension of the general health condition. Sagittal balance was correlated with lumbar kyphosis angle, body pain and overall health status, and T1 pelvic angle was correlated with lumbar lordosis angle, sagittal balance, body pain and overall health status. (3) the results showed that internal fixation with transpedicular osteotomy screw could effectively reconstruct the shape of spine and pelvis sagittal plane of degenerative thoracolumbar kyphosis, relieve pain and improve the quality of life of patients with degenerative thoracolumbar kyphosis.
【作者单位】：河北省沧州中西医结合医院脊柱外科;
【分类号】：R687.31

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