摘要
目的:基于矢状面形态特点对退行性腰椎滑脱症(degenerative spondylolisthesis,DS)进行分型,评价其在腰椎侧前方入路手术治疗DS中的指导价值.方法:回顾性分析2015年1月~2016年12月我院收治的37例L4 DS患者的临床资料,其中男15例,女22例;年龄50~67岁(58.5±9.5岁).由3名观察者分别根据DS患者术前L4/5节段矢状面形态分为3型:(1)开口型,腰椎滑脱角(slip angle,SA)>5°;(2)平行型,0°≤SA≤5°;(3)闭口型,SA<0°.所有患者均采用侧前方腰椎椎间融合术(anterolateral lumbar interbody fusion,ALLIF)治疗,术中参照患者矢状位形态分型调整手术体位摆放、cage置入位置和固定等.测量术前及术后腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)和脊柱矢状面平衡(sagittal vertical axis,SVA);评估术前及术后末次随访时的腰痛和下肢痛疼痛视觉模拟评分(visual analogue scale,VAS)、腰椎Oswestry功能障碍指数(Oswestry disability index,ODI)和健康调查简表(the MOS item short from health survey,SF-36)评分.对3名观察者的分型结果进行Kappa一致性检验,并对各组患者临床资料进行统计学分析.结果:3名观察者之间分型的一致性Kappa值为0.826~0.894,观察者自身的一致性Kappa值为0.875~0.916,均高度一致.37例DS患者中开口型12例(A组),平行型17例(B组),闭口型8例(C组),术前各组间LL、PT、SS具有统计学差异(P<0.05),C组LL、SS显著性低于其余两组(P<0.05),各组间PI、SVA无统计学差异(P>0.05);术后A、B组脊柱-骨盆矢状面参数均较术前无显著性变化(P>0.05),而C组PT较术前显著性降低,SS、LL显著性增加(P<0.05).术前C组患者腰痛VAS显著大于其余两组(P<0.05),术后各组腰痛、腿痛VAS,ODI及SF-36评分均较术前显著性改善(P<0.05),其中C组腰痛VAS、O-DI和SF-36心理健康评分改善幅度均大于其余两组(P<0.05).结论:基于DS矢状面形态特点分型简单、方便且可信度高,根据DS不同分型制定相应的ALLIF治疗策略可以获得满意的临床疗效.
Objectives:To investigate a new classification of lumbar degenerative spondylolisthesis(DS)based on the features of sagittal morphology,and evaluate its value in anterolateral approach surgery for DS.Methods:From January 2015 to December 2016,37 cases with L4 DS were analyzed retrospectively,including 15 males and 22 females.The age ranged from 50 to 67 years(58.5±9.5 years).According to sagittal morphology,the patients were divided into three groups by 3 observers:opened type with SA(sagittal slipping angle)>5°,parallel type with 0°≤SA≤5°,and closed type with SA<0°.All patients were treated with anterolateral lumbar interbody fusion(ALLIF).In the surgical procedure,operative position,cage placement and fixation were adjusted according to sagittal morphology type.The followings were recorded:the pre-and postoperative spino-pelvic parameters including lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal vertical axis(SVA),and clinical scores including VAS for low-back and leg pain,ODI for functional disability,SF-36 for quality of life.The Kappa consistency test was performed on the classification results from the three observers,and the clinical data of each group was also statistically analyzed.Results:The Kappa of intra-observer agreement was 0.826-0.894,and the Kappa of intra-observer was 0.875-0.916,both of which were highly consistent.Of the 37 patients,12 cases were open type(group A),17 cases were parallel type(group B),and 8 cases were closed type(group C).There were significant differences of preoperative PT,SS and LL among the groups(P<0.05),and closed type had the lowest LL and SS in all subtypes(P<0.05),but no difference was found in PI and SVA(P>0.05).There was no significant change in spino-pelvic parameters of group A and B before and after surgery(P>0.05).While in group C,PT decreased,and SS,LL increased significantly(P<0.05).The preoperative VAS for low back pain in group C was significantly higher than those in the other two groups(P<0.05).The postoperative VAS for low back pain and leg pain,ODI,SF-36 scores were significantly improved(P<0.05).The improvement of VAS for low back pain,ODI and SF-36 mental component summary(MCS)scores in group C were greater than those in the other two groups(P<0.05).Conclusions:This new sagittal morphological classification system is a simple and reliable method for classifying DS cases,based on which the ALLIF treatment can achieve satisfactory clinical outcomes.
作者
李亚伟
王冰
吕国华
李磊
戴瑜亮
涂志明
LI Yawei;WANG Bing;Lu Guohua(Department of Spine Surgery,the Second Xiangya Hospital of Central South University,Changsha,Hu'nan,410011,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2019年第11期977-983,共7页
Chinese Journal of Spine and Spinal Cord
基金
国家自然科学基金青年基金（81601868）
湖南省自然科学基金青年项目（2018JJ3572)
关键词
退行性腰椎滑脱症
侧前方腰椎椎间融合术
矢状位形态分型
脊柱-骨盆参数
Lumbar degenerative spondylolisthesis
Anterolateral lumbar interbody fusion
Sagittal morphology classification
Spinopelvic parameters
