CAJ | 학술논문

目的：探讨复位在治疗成人重度腰椎滑脱中对脊柱骨盆平衡的作用及临床疗效。方法：回顾分析2008年8月至2011年8月应用后路复位技术治疗Ⅲ度及Ⅲ度以上（Meyerding分类）的成人腰椎滑脱患者16例，男9例，女7例；年龄24～65岁，平均44岁。通过脊柱全长侧位X线片测量比较术前、术后2周、末次随访脊柱-骨盆矢状位参数，包括骶骨倾斜角（sacral slope，SS），骨盆倾斜角（pelvic tilt，PT），骨盆入射角（pelvic incidence，PI），腰椎前凸角（lumbar lordosis，LL），矢状面轴向垂线（sagittal vertical axis，SVA）；三维重建CT判断骨融合情况；记录手术并发症；临床0swestry功能障碍评分（ODI）评估临床疗效。结果：16例患者均获随访，时间12～24个月，平均18个月。4例完全复位，8例复位至I度，4例复位至Ⅱ度；PI术前与术后2周无统计学差异（P＞0．05），术后2周与末次无统计学差异（P＞0．05）；SS、PT、LL、SVA术前与术后2周比较有统计学差异（P＜0．05），术后2周与末次比较无统计学差异（P＞0．05）。临床ODI评分由术前的36．6±4．2下降至末次随访时的14．7±4．0（P＜0．05）。所有病例术后1年薄层螺旋CT扫描三维重建可见椎间骨小梁连接，达到骨性融合。3例出现神经根性疼痛，药物治疗后恢复；无感染、内固定松动及断裂。结论：手术复位在治疗成人重度腰椎滑脱中能够明显改善脊柱-骨盆矢状位排列，并获得良好疗效。
목적：탐토복위재치료성인중도요추활탈중대척주골분평형적작용급림상료효。방법：회고분석2008년8월지2011년8월응용후로복위기술치료Ⅲ도급Ⅲ도이상（Meyerding분류）적성인요추활탈환자16례，남9례，녀7례；년령24～65세，평균44세。통과척주전장측위X선편측량비교술전、술후2주、말차수방척주-골분시상위삼수，포괄저골경사각（sacral slope，SS），골분경사각（pelvic tilt，PT），골분입사각（pelvic incidence，PI），요추전철각（lumbar lordosis，LL），시상면축향수선（sagittal vertical axis，SVA）；삼유중건CT판단골융합정황；기록수술병발증；림상0swestry공능장애평분（ODI）평고림상료효。결과：16례환자균획수방，시간12～24개월，평균18개월。4례완전복위，8례복위지I도，4례복위지Ⅱ도；PI술전여술후2주무통계학차이（P＞0．05），술후2주여말차무통계학차이（P＞0．05）；SS、PT、LL、SVA술전여술후2주비교유통계학차이（P＜0．05），술후2주여말차비교무통계학차이（P＞0．05）。림상ODI평분유술전적36．6±4．2하강지말차수방시적14．7±4．0（P＜0．05）。소유병례술후1년박층라선CT소묘삼유중건가견추간골소량련접，체도골성융합。3례출현신경근성동통，약물치료후회복；무감염、내고정송동급단렬。결론：수술복위재치료성인중도요추활탈중능구명현개선척주-골분시상위배렬，병획득량호료효。
Objective:To explore the effect of reduction on spino pelvic balance in treating high grade lumbar spondy-lolisthesis. Methods:From Augest 2008 to Augest 2011,the data of 16 patients with high grade lumbar spodylolisthesis (Mey-erding gradeⅢor more than gradeⅢ) underwent reduction treatment through posterior approach were retrospectively ana-lyzed. There were 9 males and 7 females ,aged from 24 to 65 years old with an average of 44 years. Preoperative ,postoperative at 2 weeks and final follow up,spino pelvic parameters of all patients were measured and compared by total legth lateral X rays,and spino pelvic parameters included sacral slope (SS),pelvic tilt (PT),pelvic incidence (PI),lumbar lordosis (LL) and sagittal vertical axis (SVA);the informations of intervertebral bone fusion was observed by CT and postoperative complications were recorded;clinical effects were assessed according to clinical Oswestry score (CODI). Results:All patients were followed up from 12 to 24 months with an average of 18 months. Four cases reduced anatomically ,8 cases reduced to gradeⅠ,4 cases reduced to gradeⅡ. There was statistically significant differences in sacral slope (SS),pelvic tilt (PT),lumbar lordosis angle (LL) and sagittal vertical axis (SVA) between before operation and two weeks after operation (P<0.05),while pelvic inci-dence (PI) no statistically significant differences was found between before operation and two weeks after operation (P>0.05). There was no statistically significant differences in SS,PT,LL,SVA,PI between two weeks after operation and final follow up (P>0.05). CODI had decreased from preoperative 36.6±4.2 to 14.7±4.0 at final follow up (P<0.05). One year after operation, all patients obtained bone fusion and can find the union of bone trabeculae by three dimensional reconstruction CT. Three cas-es occurred transient nerve root pain ,and recovered after medicinal treatment. No infection and internal fixation loosening and breakage were found. Conclusion:Surgical reduction for high grade lumbar spondylolisthesis can improve spino pelvic balance and acquire satisfactory outcomes.