摘要
目的 分析影响成人退行性脊柱侧凸(ADS)患者术后2年功能性预后的危险因素,并探讨基于脊柱矢状面平衡的手术策略.方法 纳入2018年5月—2020年5月应急总医院采用后路融合内固定术矫形的ADS患者79例,记录其年龄、性别、体质量指数(BMI)等一般资料,采集患者术前及术后2年的Oswestry功能障碍指数(ODI)、脊柱侧凸研究学会22项患者问卷(SRS-22)评分、腰背部和下肢疼痛视觉模拟量表(VAS)评分,测量术前及术后2年的骨盆倾斜角(PT)、骨盆投射角(PI)、腰椎前凸角(LL)、矢状面垂直偏距(SVA)、冠状面平衡、T1 骨盆角(T1PA)及PI-LL,记录并统计术后并发症发生情况.根据术后2年ODI将患者分为功能最佳组(ODI≤15%)和功能最差组(ODI>50%),比较2组患者各指标的差异,采用多因素logistic回归分析评价术后功能的影响因素.结果 79例患者总体并发症发生率为41.8%(33/79),术后2年ODI、SRS-22评分、腰背部疼痛VAS评分较术前改善,差异均有统计学意义(P<0.05).术后2年功能最差组21例,功能最佳组30例.功能最差组患者BMI、术后重症并发症发生率高于功能最佳组;术前ODI、SRS-22评分差于功能最佳组,术前矢状面失衡(SVA≥5 cm)患者比例高于功能最佳组;术后2年ODI、SRS-22评分、腰背部和下肢痛VAS评分差于功能最佳组,矢状面失衡患者比例、PI-LL和T1PA高于功能最佳组;差异均有统计学意义(P<0.05).多因素logistic回归分析结果显示,高BMI、术前高ODI、术后2年SVA≥5 cm和术后2年高T1PA是预后不良的危险因素.结论 手术矫形能够改善ADS患者的功能和生活质量,BMI、术前ODI、术后2年SVA和术后2年T1PA影响术后功能恢复,故应基于脊柱矢状面整体平衡状态制订ADS手术策略.
Abstract
Objective To explore the risk factors associated with functional outcome at 2 years after surgery in adult degenerative scoliosis(ADS)patients,and discuss the surgical strategy based on the spinal sagittal balance.Methods A total of 79 ADS patients who underwent posterior fusion internal fixation surgery at the Emergency General Hospital from May 2018 to May 2020 were included.The general information such as age,gender,body mass index(BMI)were recorded.The Oswestry disability index(ODI),Scoliosis Research Society-22 patient questionnaire(SRS-22)score,low back and leg pain visual analogue scale(VAS)scores,the pelvic tilt(PT),pelvic incidence(PI),lumbar lordosis(LL),sagittal vertical axis(SVA),coronal balance,T1 pelvic angle(T1PA)and PI-LL at pre-operation and postoperative 2 years were recorded.The incidence of postoperative complications were recorded.According to the ODI at postoperative 2 years,patients were divided into the best function group(ODI≤15%)and the worst function group(ODI>50%).The differences in various indicators between the 2 groups were compared,and the influencing factors of postoperative function were evaluated using multivariate logistic regression analysis.Results The overall incidence of complications in 79 patients was 41.8%(33/79),and the ODI,SRS-22 score and low back pain VAS score at postoperative 2 years were all improved compared to the pre-operation,with a statistical significance(P<0.05).At postoperative 2 years,there were 21 cases in the worst function group and 30 cases in the best function group.In the worst function group the BMI and incidence of severe postoperative complications were higher than those in the best function group;the preoperative ODI and SRS-22 score were lower than those in the best function group,and the proportion of patients with sagittal imbalance(SVA≥5 cm)at pre-operation was higher than that in the best function group;the ODI,SRS-22 score,low back and leg pain VAS scores at postoperative 2 years were worse than those in the best function group;the proportion of patients with sagittal imbalance,PI-LL,and T1PA at postoperative 2 years were higher than those in the best function group;and the differences were statistically significant(P<0.05).The multivariate logistic regression analysis showed that high BMI,high preoperative ODI,SVA≥5 cm and high T1PA at postoperative 2 years were risk factors for poor prognosis.Conclusions Surgical correction can improve the function and life quality of ADS patients.BMI,preoperative ODI,SVA and T1PA at postoperative 2 years affect postoperative functional recovery.Therefore,an ADS surgical strategy should be developed based on the spinal sagittal balance.
维普
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