輕度峽部裂性腰椎滑脫癥融合前后脊柱-骨盆矢狀位參數及臨床療效分析_《中國修復重建外科雜志》

作者：

李亮 , 隋海濤 , 于學忠 , 姜保恩

東營市人民醫院創傷骨科（山東東營，257091）;

關鍵詞：

峽部裂性腰椎滑脫癥脊柱-骨盆參數矢狀位平衡后路腰椎椎體間融合

DOI：

10.7507/1002-1892.20130291

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目的探討經后路腰椎椎間Cage融合術加椎弓根固定術治療輕度峽部裂性腰椎滑脫癥手術前后脊柱-骨盆矢狀位參數變化及其與手術療效的關系。方法回顧分析2009年10月－2011年10月經后路腰椎椎間Cage融合術加椎弓根固定術治療的30例輕度峽部裂性腰椎滑脫癥患者臨床資料。男14例，女16例；年齡48～67歲，平均56.7歲。術前及末次隨訪時攝站立位脊柱全長正、側位X線片，測量滑脫相關參數[滑移百分數（percentage of slipping，PS）、椎間隙高度、滑脫角（angle of slip，AS）]，脊柱相關參數[胸椎后凸角（thoracic kyphosis，TK）、胸腰聯合角（thoracolumbar junction，TLJ）、C7矢狀位平衡（sagittal vertical axis，SVA）、腰椎前凸角（lumbar lordosis，LL）、脊柱-骨盆角（spino-sacral angle，SSA）]和骨盆相關參數[骶骨傾斜角（sacral slope，SS）、骨盆傾斜角（pelvic tilt，PT）、骨盆入射角（pelvic incidence，PI）]；記錄患者手術前后Oswestry功能障礙指數（ODI）評分。分析手術前后影像學參數以及ODI評分變化，并采用Pearson相關分析影像學參數及功能評分變化值間的相關性。結果患者術后滑脫相關參數及ODI評分與術前比較差異均有統計學意義（P lt; 0.05）；脊柱、骨盆相關參數中，除TLJ和TK外，其余各參數手術前后比較差異均有統計學意義（P lt; 0.05）。SVA變化值與PS、PI、PT、LL、SS、AS、SSA及ODI變化值間存在線性相關；SSA變化值與PS、PI、LL、SS、AS、PT及ODI變化值間存在線性相關。結論經后路腰椎椎間Cage融合術加椎弓根固定可明顯改善輕度峽部裂性腰椎滑脫癥患者的脊柱-骨盆矢狀位平衡狀態，SVA及SSA重建能獲得更好的手術療效。

引用本文： 李亮,隋海濤,于學忠,姜保恩. 輕度峽部裂性腰椎滑脫癥融合前后脊柱-骨盆矢狀位參數及臨床療效分析. 中國修復重建外科雜志, 2013, 27(11): 1338-1344. doi: 10.7507/1002-1892.20130291 復制

1.	Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2.	Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3.	Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4.	李鵬飛, 賈楠, 靳憲輝, 等. 椎間植骨粒體積對腰椎后路滑脫復位植骨融合內固定術后融合效果的影響. 中國修復重建外科雜志, 2013, 27(6): 696-702.
5.	Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6.	海涌, 趙會, 邵楠, 等. 腰椎融合術后下腰痛與腰椎矢狀位序列的關系. 中華醫學雜志, 2013, 93(15): 1129-1132.
7.	Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8.	Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9.	Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10.	Bourghli A, Aunoble S, Reebye O, et al. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J, 2011, 20 Suppl 5: 663-668.
11.	賈俊峰, 趙杰, 陳志明, 等. 腰椎峽部裂型滑脫癥矢狀位參數分析. 中國矯形外科雜志, 2007, 15(11): 850-852.
12.	Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13.	Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14.	Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15.	劉勇, 劉臻, 朱鋒, 等. 成人腰椎峽部裂性滑脫癥與退變性滑脫癥患者脊柱骨盆矢狀面形態學研究. 中國脊柱脊髓雜志, 2013, 23(4): 307-311.
16.	Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17.	Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18.	Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19.	Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20.	Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21.	Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis -spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
22.	Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23.	Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24.	Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25.	Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26.	Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27.	Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28.	Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29.	徐寶山, 馬信龍. 脊柱骨盆矢狀力線在脊柱疾患中的意義. 中華骨科雜志, 2012, 32(1): 80-85.
30.	Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31.	Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32.	Haka?o J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33.	Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34.	Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35.	Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36.	Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37.	Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

1. Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2. Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4. 李鵬飛, 賈楠, 靳憲輝, 等. 椎間植骨粒體積對腰椎后路滑脫復位植骨融合內固定術后融合效果的影響. 中國修復重建外科雜志, 2013, 27(6): 696-702.
5. Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6. 海涌, 趙會, 邵楠, 等. 腰椎融合術后下腰痛與腰椎矢狀位序列的關系. 中華醫學雜志, 2013, 93(15): 1129-1132.
7. Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8. Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9. Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10. Bourghli A, Aunoble S, Reebye O, et al. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J, 2011, 20 Suppl 5: 663-668.
11. 賈俊峰, 趙杰, 陳志明, 等. 腰椎峽部裂型滑脫癥矢狀位參數分析. 中國矯形外科雜志, 2007, 15(11): 850-852.
12. Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13. Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14. Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15. 劉勇, 劉臻, 朱鋒, 等. 成人腰椎峽部裂性滑脫癥與退變性滑脫癥患者脊柱骨盆矢狀面形態學研究. 中國脊柱脊髓雜志, 2013, 23(4): 307-311.
16. Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19. Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20. Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21. Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis -spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
22. Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23. Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25. Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26. Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27. Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28. Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29. 徐寶山, 馬信龍. 脊柱骨盆矢狀力線在脊柱疾患中的意義. 中華骨科雜志, 2012, 32(1): 80-85.
30. Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31. Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32. Haka?o J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33. Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35. Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36. Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

《中國修復重建外科雜志》

輕度峽部裂性腰椎滑脫癥融合前后脊柱-骨盆矢狀位參數及臨床療效分析

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《中國修復重建外科雜志》

輕度峽部裂性腰椎滑脫癥融合前后脊柱-骨盆矢狀位參數及臨床療效分析

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