目的 利用 Roussouly 分型对固定至骶骨/骨盆的退行性脊柱侧凸(degenerative scoliosis,DS)术后临床疗效和影像学参数特点进行评估,分析其机械性并发症的危险因素,探索 Roussouly 分型于腰椎长节段固定手术的意义.方法 回顾分析 2017 年 12 月至 2020 年 12 月因 DS 于我院进行长节段腰骶/骨盆融合手术的 45 例患者,其中男 7 例,女 38 例,年龄 55～85 岁,平均(70.84±8.52)岁,根据是否符合 Roussouly分型分为符合 Roussouly 分型(RG)组(n=10)和不符合 Roussouly 分型(NRG)组(n=35);比较两组一般资料,术前及末次随访腰痛视觉模拟评分(visual analogue scale,VAS)、腰椎 Oswestry 功能障碍指数(Oswestry disability index,ODI)、健康相关生活质量(health related quality of life,HRQoL)以及机械性并发症发生情况,两组脊柱-骨盆影像学相关参数,包括冠状位 Cobb's 角、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、腰椎前凸角(lumbar lordosis,LL)、腰椎前凸分布指数(lordosis distribution index,LDI)、腰椎前凸椎体数(the number of vertebrae included in the lordosis,NVL)、前凸顶点(the lumbar sagittal apex,LA)、拐点(inflexion point,IP).根据术后是否发生机械性并发症进行分组,将 Roussouly 分型相关矢状面参数纳入单因素分析和多因素二元 Logestic 回归分析,确定机械性并发症的独立危险因素.结果 术前 RG 和NRG 两组基线水平一致;术后 RG 组腰痛 VAS 评分 1.20±0.92 小于 NRG 组的 1.97±0.79,差异有统计学意义(P=0.01);术后 RG 组 ODI 13.40±3.69 小于 NRG 组的 21.40±7.66,差异有统计学意义(P=0.003);术后RG 组 SF-36 评分 75.68±4.81 高于 NRG 的 68.25±6.30,差异有统计学意义(P=0.001);RG 组 LL(48.20±8.48)° 大于 NRG 组的(40.33±5.22)°,差异有统计学意义(P=0.001),RG 组 SVA 24.55 mm 小于 NRG 组的40.84 mm,差异有统计学意义(P=0.03);两组机械性并发症发生率差异有统计学意义(P=0.04);术后 PI(OR=0.797;95%CI=0.657～0.968;P=0.022),LA(OR=0.027;95%CI=0.002～0.438;P=0.011)为术后发生机械性并发症的独立危险因素.结论 术后符合理想 Roussouly 分型的 DS 患者可以获得更好的临床疗效,同时机械性并发症也较少,骨盆 PI值较小、前凸顶点位置较高会增加 DS术后机械性并发症的发生.
Clinical study on Roussouly classification to evaluate sagittal morphology and predict mechanical complications after surgery for degenerative scoliosis
Objective To evaluate the clinical efficacy and imaging parameters of postoperative degenerative scoliosis fixed to the sacrum/pelvis using Roussouly classification,analyze the risk factors for mechanical complications,and explore the significance of Roussouly classification in lumbar long-segment fixation surgery.Methods A retrospective analysis was conducted on 45 patients who underwent long-segment lumbar sacral/pelvic fusion surgery for degenerative scoliosis at Henan Provincial People's Hospital from December 2017 to December 2020.Among them,7 were males and 38 were females,aged 55-85 years with an average age of(70.84±8.52)years.According to whether they met the Roussouly classification,they were divided into the Roussouly classification(RG)group(n=10)and the non-Roussouly classification(NRG)group(n=35);General data including visual analog scale(VAS),lumbar Oswestry disability index(ODI),health-related quality of life(QOL),and the occurrence of mechanical complications were compared between the two groups.Parameters related to spinal pelvic imaging,such as coronal Cobb's angle,pelvic incidence angle(PI)sacral slope angle(SS),lumbar lordosis angle(LL),lumbar lordosis distribution index(LDI),the number of vertebrae included in the lordosis(NVL),the lumbar sagittal apex(LA),and inflection point(IP)were compared between the two groups.Based on whether mechanical complications occurred after surgery,the Roussouly classification related sagittal parameters were included in univariate analysis and multivariate binary Logistic regression analysis to determine independent risk factors for mechanical complications.Results The baseline levels of RG and NRG were consistent before surgery;The postoperative VAS score for low back pain in the RG group(1.20±0.92)was lower than that in the NRG group(1.97±0.79),and the differences were statistically significant(P=0.01);The postoperative ODI score in the RG group was(13.40±3.69),while in the NRG group was(21.40±7.66),with statistically significant differences(P=0.003);The postoperative SF-36 score in the RG group(75.68±4.81)was higher than that in the NRG group(68.25±6.30),with statistically significant differences(P=0.001);The LL(48.20±8.48)° in the RG group was greater than that in the NRG group(40.33±5.22)°,with statistically significant differences(P=0.001).The SVA(24.55 mm)in the RG group was smaller than the 40.84 mm in the NRG group,with statistically significant differences(P=0.03).There were statistically significant differences in the incidence of mechanical complications between the two groups(P=0.04);Postoperative PI(OR=0.797;95%CI=0.657-0.968;P=0.022)and LA(OR=0.027;95%CI=0.002-0.438;P=0.011)are independent risk factors for postoperative mechanical complications.Conclusions Patients with DS who meet the ideal Roussouly classification after surgery can achieve better clinical efficacy,while having fewer mechanical complications.A smaller pelvic PI value and a higher anterior convex vertex position can increase the occurrence of mechanical complications after DS surgery.
万方数据
维普
