摘要
目的 探讨腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的关系.方法 采取回顾性方法,对2008年1至12月在北京朝阳医院骨科因腰椎退行性疾患而接受腰椎融合手术的182例患者进行随访,将术后以及随访中仍存在腰痛、且随访在24个月的患者进行站立位腰椎侧位X片检查,测量站立位腰椎侧位X线片腰椎前凸的Cobb角度,并对腰痛的VAS评分及功能障碍ODI评分进行分析.对患者腰椎矢状位曲度与正常腰椎Cobb角的差值和腰痛评分的相关性进行统计学分析,探讨下腰痛的程度与腰椎矢状位Cobb角度大小之间的关系.结果 本组42例术后出现不同程度的腰痛.其中男19例,女23例.平均年龄59.6(40 ～77)岁.测量腰椎矢状位Cobb角度:腰椎前凸角度术前平均值(40.2±10.3) (21 ～60)°；12个月随访平均值(40.1±10.6)(20 ～60)°；24个月随访平均值(40.8±10) (24 ～60)°.疼痛VAS评分:12个月随访平均值(29.4±11.5)(5～50)分；24个月随访平均值(27.6±11.7)(5～48)分.功能ODI评分:12个月随访平均值(15.1 ±5.4)(0 ～25)分；24个月随访平均值(13.9±5.2)(0～24分).腰椎前凸角度与基准数值差值:12个月随访平均值(19.9±10.6)(0～40)°；24个月随访平均值(19.2±10.0) (0～36)°.腰椎前凸角与正常值差值的大小和腰痛VAS评分之间的关系评价:12个月随访呈正相关(P＜0.01)；24个月随访呈正相关(P＜0.01)；腰椎前凸角与正常值差值的大小和ODI评分之间的关系评价:12个月随访呈正相关(P ＜0.01)；24个月随访呈正相关(P＜0.01).结论 腰椎融合术后患者的下腰痛程度与矢状位前凸丢失程度存在紧密的联系,腰椎融合手术应该将重建腰椎前凸作为重要的目标之一.
Abstract
Objective To evaluate retrospectively the relationship between low back pain and changes of lumbar spine sagittal alignment after lumbar spine fusion.Methods During January-December 2008,a total of 182 consecutive patients with degenerative lumbar spine diseases underwent posterior lumbar interbody fusion (PLIF) and the follow-up period was over 24 months.Standing lumbar spine anterioposterior and lateral radiography were taken during the follow-up and the lumbar lordosis Cobb angles were measured on radiography.Pain degrees were assessed by visual analog scale (VAS) and Oswestry disability index (ODI).The relationship between the changes of Cobb angle and lumbar sagittal plane curve was analyzed by the SPSS software.Also the relationship between back pain degree and Cobb angle was examined.Results Among them,42 cases with postoperative back pain were followed up for 24 months.There were 19 males and 23 females with a mean age of 59.6 years (range:40-77).Lumbar spine sagittal Cobb angles were measured from radiographic images:lumbar lordosis angle:① mean angle at 12-month follow-up:40.1 ° ± 10.6°,range:20°-60° ; ② mean angle at 24-month follow-up:40.8° ± 10°,range:24°-60°.Back pain of 42 patients:VAS:① mean at 12-month follow-up:29.4 ± 11.5,range:5-50 ; ② mean at 24-month followup:27.6 ± 11.7,range:25-48.Lumbar spine function of 42 patients:ODI:① mean at 12-month follow-up:15.1 ±5.4,range:0-25 ;② mean at 24-month follow-up:13.9 ± 5.2,range:0-24.Difference between lumbar lordosis angle and standard score:① mean angle at 12-month follow-up:19.9° ± 10.6°,range:0°-40°; ② mean angle at 24-month follow-up:19.2° ± 10.0°,range:0°-36°.Angle difference versus back pain VAS:① at 12-month follow-up:P ＜ 0.001,positive correlation; ② 24-month follow-up:P ＜ 0.001,positive correlation; angle difference versus back pain ODI:① 12-month follow-up:P ＜ 0.001,positive correlation; ② 24-month follow-up:P ＜ 0.001,positive correlation.Conclusion There is a close relationship between back pain after fusion and loss of lumbar sagittal lordosis.And reconstruction of lumbar lordosis should be one important goal for lumbar fusion.
NETL
NSTL
维普
万方数据