摘要
背景:目前针对创伤后僵硬性胸腰椎后凸畸形的研究多集中于整体矢状面平衡及手术干预,而病程对腰椎代偿性曲度改变及退变影响尚不明确。目的:探讨创伤后僵硬性胸腰椎后凸畸形患者病程对腰椎退变的影响及潜在机制,为优化治疗策略提供依据。方法:回顾性分析79例创伤后僵硬性胸腰椎后凸畸形患者的临床和影像资料,根据病程分为2组,病程≤5年为A组(n=40),病程>5年为B组(n=39)。采用X射线图像测量伤椎局部后凸角、伤椎及相邻上下椎体后壁高度、腰椎前凸角、各节段腰椎椎间隙角度、骶骨倾斜角,通过Weishaupt-CT分类系统评估患者各节段腰椎小关节退变程度,Pfirrmann-MRI分级评估各节段椎间盘退变状况。比较两组患者腰背痛目测类比评分、Oswestry功能障碍指数、SRS-22评分量表及美国脊髓损伤协会脊髓损伤分级。分析病程对创伤后僵硬性胸腰椎后凸畸形患者临床症状及影像学特征的影响。结果与结论:①两组患者年龄、性别、腰背痛目测类比评分、骨折部位、骨折形态和美国脊髓损伤协会分级比较差异无显著性意义(P>0.05);A组患者SRS-22评分亚总分显著高于B组(P<0.05);B组Oswestry功能障碍指数显著高于A组(P<0.05);②B组伤椎后凸角度、腰椎前凸角度、L_(4/5)节段椎间隙角度显著大于A组(P<0.05);③A组L_(1/2)、L_(2/3)、L_(3/4)、L_(5)/S_(1)椎间隙角度及骶骨倾斜角与B组相比差异无显著性意义(P>0.05);④B组L_(3/4)、L_(4/5)、L_(5)/S_(1)节段关节突退变程度显著重于A组(P<0.05);B组L_(2/3)、L_(3/4)、L_(4/5)、L_(5)/S_(1)椎间盘退变程度显著重于A组(P<0.05);⑤Pearson相关性分析结果显示,B组内病程与伤椎局部后凸角度及腰椎前凸角度呈正相关(r=0.335,0.418,P<0.05);⑥创伤后僵硬性胸腰椎后凸畸形患者在长期代偿过程中,会导致腰椎前凸加大、腰椎退变加速;在腰椎曲度代偿中,L_(4/5)为主要代偿节段,进行手术矫正时应特别注意下腰椎的曲度纠正。
BACKGROUND:Currently,most studies on rigid post-traumatic thoracolumbar kyphosis focus on overall sagittal balance and surgical intervention,while the effect of the disease duration on the change of lumbar compensatory curvature and degeneration is still unclear.OBJECTIVE:To explore the effect of the disease duration on lumbar degeneration and the potential mechanism of rigid post-traumatic thoracolumbar kyphosis in patients with rigid post-traumatic thoracolumbar kyphosis,and provide a basis for optimizing treatment strategies.METHODS:Clinical and imaging data from 79 rigid post-traumatic thoracolumbar kyphosis patients were retrospectively analyzed.The patients were divided into two groups according to the disease duration:Patients with a disease duration of≤5 years were categorized as group A(n=40),and those with>5 years as group B(n=39).X-ray images were used to measure the local kyphosis angle of the injured vertebra,the height of the posterior walls of the injured vertebra and adjacent vertebrae,lumbar lordosis,the intervertebral space angle for each lumbar segment,and sacral slope.The Weishaupt-CT classification system was employed to assess lumbar facet joint degeneration.Pfirrmann-MRI grading system was applied to evaluate disc degeneration.The visual analog scale for back pain,Oswestry Disability Index,SRS-22 and American Spinal Injury Association spinal injury grading were compared between the groups.The impact of disease duration on clinical symptoms and imaging characteristics of patients with rigid post-traumatic thoracolumbar kyphosis was analyzed.RESULTS AND CONCLUSION:(1)There were no significant differences in age,gender,visual analog scale scores,fracture location,fracture type,or American Spinal Injury Association grading between the two groups(P>0.05).Group A had a significantly higher SRS-22 score than group B(P<0.05);Group B had a significantly higher Oswestry Disability Index score than group A(P<0.05).(2)Group B had a substantially greater kyphosis angle of the injured vertebra,lumbar lordosis,and L_(4/5) intervertebral space angle than group A(P<0.05).(3)There were no significant differences between groups A and B in the L_(1/2),L_(2/3),L_(3/4),or L_(5)/S_(1) intervertebral space angles or sacral slope(P>0.05).(4)Group B showed significantly greater facet joint degeneration at the L3/4,L4/5,and L5/S1 segments and significantly greater disc degeneration at the L_(2/3),L_(3/4),L_(4/5),and L_(5)/S_(1) segments compared with group A(both P<0.05).(5)Pearson correlation analysis indicated a positive correlation between disease duration and both the local kyphosis angle of the injured vertebra and lumbar lordosis in group B(r=0.335,0.418,P<0.05).(6)Over time,rigid post-traumatic thoracolumbar kyphosis patients experience increased lumbar lordosis and accelerated lumbar degeneration,with the L_(4/5) segment playing a primary role in compensatory lumbar curvature.Surgical correction should focus on adjusting the lower lumbar curvature.
作者
阳俊杰
张浩
陈志科
陈遥
贾秉谞
王清
李广州
王高举
Yang Junjie;Zhang Hao;Chen Zhike;Chen Yao;Jia Bingxu;Wang Qing;Li Guangzhou;Wang Gaoju(Affiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan Province,China;Suining Central Hospital,Suining 629018,Sichuan Province,China)
出处
《中国组织工程研究》
北大核心
2026年第21期5534-5540,共7页
Chinese Journal of Tissue Engineering Research
基金
德阳市第二人民医院-西南医科大学科技战略合作项目(2022DYEXNYD007),项目负责人:李广州。
关键词
创伤后僵硬性胸腰椎后凸畸形
腰椎前凸
关节突退变
腰椎间盘退变
病程
腰椎曲度
rigid post-traumatic thoracolumbar kyphosis
lumbar lordosis
facet joint degeneration
lumbar intervertebral disc degeneration
disease duration
lumbar curvature
