退变性脊柱侧凸术后脊柱-骨盆-参数特点及生活质量相关性分析

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目的研究退变性脊柱侧凸患者长节段固定术后脊柱-骨盆参数：矢状面躯干偏移(sagital vertical axis，SVA)、胸椎后凸角(thoracic kyphosis，TK)、骶骨倾斜角(sacral slope，SS)、骨盆倾斜角(pelvic tilt，PT)、骨盆投射角(pelvic incidence，PI)、T1骨盆角(T1 pelvic angle，TPA)、PI与腰椎前凸角(lumbar lordosis，LL)之差PI-LL的特点，并分析总结各参数与患者生活质量评分的相关性。方法回顾性分析2013年3月至2018年5月在我院就诊的退变性脊柱侧凸32例患者资料，男10例，女22例；年龄60.0~73.0岁，平均年龄(64.0±3.5)岁。均采用后路长节段固定方式治疗，术后测量其脊柱-骨盆参数，并填写国际脊柱侧凸研究学会量表(scoliosis research society，SRS-22)、Oswestry功能障碍指数(oswestry disability index，ODI)及视觉模拟评分(visual analogue scale，VAS)，统计分析其相关性。结果患者术后的SVA、LL、PT及PI-LL与SRS-22评分、ODI评分、背部疼痛VAS评分及下肢疼痛VAS评分密切相关。其中SVA、LL分别与SRS-22评分中的所有子项呈显著负相关，而与背部疼痛VAS评分呈显著正相关(P＜0.05)；TK与SRS-22评分中的自我形象、心理状况及治疗满意度呈显著正相关(P＜0.05)，而TPA与SRS-22评分中的疼痛、自我形象呈显著负相关(P＜0.05)； PI-LL与SRS-22评分中的疼痛也呈显著负相关(P＜0.05)。PT，TPA，PI-LL分别与ODI评分及背部疼痛VAS评分呈显著正相关(P＜0.05)；而PI、SS与所有评分则无显著相关性(P＞0.05)，所有脊柱-骨盆参数均与下肢疼痛VAS评分无显著相关性(P＞0.05)。结论退变性脊柱侧凸患者术后SVA、LL、PT及PI-LL等脊柱-骨盆参数与术后生活质量评分SRS-22、ODI、背部疼痛VAS评分密切相关，PI及SS与所有评分无显著性相关。针对脊柱-骨盆参数SVA、LL、PT及PI-LL，良好的术前设计有助于取得最佳的术后疗效。

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关键词 ：退变性脊柱侧凸, 脊柱-骨盆参数, 长节段固定, 生活质量评分

Abstract：Objective To retrospectively study the spinal-pelvic parameters after long segment fixation in patients with degenerative scoliosis，including sagital vertical axis(SVA)，thoracic kyphosis(TK)，sacral slope(SS)，pelvic tilt(PT)，pelvic incidence(PI)，T1 pelvic angle(TPA)，analyze the difference between the parametersand(PI-LL) and study the correlation between the parameters and the score of quality of life.Methods 32 patients with degenerative scoliosis treated in our hospital from March 2013 to May 2018 were analyzed retrospectively，including 10 males and 22 females.The patients aged from 60.0 to 73.0 years with an average age of (64.0±3.5) years.All patients were treated with posterior long segmental fixation.The spine-pelvic parameters were measured after operation，and the correlation was statistically analyzed by filling in the International Scoliosis Research Society scale(scoliosis research society，SRS-22)，Oswestry disability index(ODI) and visual analogue scale(VAS).Results The postoperativeparameters SVA，LL，PT and PI-LL were closely correlated with SRS-22 score，ODI score，back pain VAS score.SVA was significantly correlated with all sub-items of SRS-22 score and VAS score(P＜0.05).TK was significantly correlated with self-image，psychological status and treatment satisfaction in SRS-22 score(P＜0.05).LL was significantly correlated with all subitems of SRS-22 score，ODI score and back painVAS score (P＜0.05).PT was significantly correlated with ODI score and back pain VAS score (P＜0.05).TPA was significantly correlated with pain，self-image of SRS-22 score，ODI score and back pain VAS score SRS-22 score (P＜0.05).PI-LL was significantly correlated with pain of SRS-22 score，ODI and back pain VAS score(P＜0.05).PI and SS had no significant correlation with all scores，and all spine-pelvic parameters had no significant correlation with lower limb pain VAS score(P＞0.05).Conclusion Postoperative spine-pelvic parameters such as SVA，LL，PT and PI-LL in patients with degenerative scoliosis are closely related to postoperative quality of life score SRS-22，ODI and back pain VAS score，while PI and SS are not significantly correlated with all scores.Appropriate preoperative design for spine-pelvic parameters SVA，LL，PT and PI-LL is helpful to achieve the best postoperative efficacy.

Key words： degenerative scoliosis spine-pelvic parameters long segment fixation quality of life score

基金资助:河南省科技攻关计划省部共建项目(SBGJ2018076)
河南省科技攻关计划省部共建项目(SB201901085)

通讯作者: 高延征

作者简介: 胡巍然(1991－ )，男，主治医师，河南省人民医院脊柱脊髓外科，450000。

引用本文:

胡巍然，施新革，王红强，朱宇，宋月鹏，高延征 *. 退变性脊柱侧凸术后脊柱-骨盆-参数特点及生活质量相关性分析[J]. 实用骨科杂志, 2020, 26(6): 481-486.
Hu Weiran，Shi Xinge，Wang Hongqiang，et al. Correlation Analysis of Spine-pelvic Parameters and Quality of Life After Long Segmental Fixation of Degenerative Scoliosis. sygkzz, 2020, 26(6): 481-486.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I6/481

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