CAJ | 학술논문

　　目的对比退行性脊柱侧弯患者长短节段固定差异及对脊柱三维平衡的影响。方法回顾研究2005年6月-2012年1月在我院接受脊柱手术患者30例，其中长节段融合固定组18例，短节段融合固定组12例。对两组手术前后的腰椎Cobb角、腰椎前凸角(lumbar lordosis，LL)、骨盆倾斜角(pelvic tilt，PT)、垂直穿过骶骨终板中点的直线与骶骨终板中点和双侧股骨头中点的连线之间的夹角(pelvic incidence，PI)、骶骨终板平面与水平线之间的夹角(sacral slope，SS)、矢状面轴向垂线(sagittal vertical axis，SVA)、自然站立位时顶椎至骶骨中线铅垂线偏移距离(central sacral vertical line distance，CSVL)、nash-moe椎体旋转分级，患者术前术后Oswestry(ODI)功能障碍评分等指标进行比较及相关研究。结果手术前后患者LL(术前P=0.032＜0.05，术后P=0.019＜0.05)、PT(术前P=0.046＜0.05，术后P=0.008＜0.05)、CSVL(术前P=0.046＜0.05，术后P=0.020＜0.05)与ODI评分差异有统计学意义。手术前后Cobb(术前P=0.342＞0.05，术后P=0.741＞0.05)、nash-moe(术前P=0.433＞0.05，术后P=0.227＞0.05)与ODI评分差异无统计学意义。结论长节段固定可重建脊柱三维序列，冠状面重建目的为整体平衡，术前平衡良好时矫形率不宜过高。长节段融合在纠正脊柱侧弯曲率和整体失衡比短节段融合更好，对于严重的Cobb角旋转性半脱位，应选择长节段融合以最大限度地减少相邻节段病变。
　　목적대비퇴행성척주측만환자장단절단고정차이급대척주삼유평형적영향。방법회고연구2005년6월-2012년1월재아원접수척주수술환자30례，기중장절단융합고정조18례，단절단융합고정조12례。대량조수술전후적요추Cobb각、요추전철각(lumbar lordosis，LL)、골분경사각(pelvic tilt，PT)、수직천과저골종판중점적직선여저골종판중점화쌍측고골두중점적련선지간적협각(pelvic incidence，PI)、저골종판평면여수평선지간적협각(sacral slope，SS)、시상면축향수선(sagittal vertical axis，SVA)、자연참립위시정추지저골중선연수선편이거리(central sacral vertical line distance，CSVL)、nash-moe추체선전분급，환자술전술후Oswestry(ODI)공능장애평분등지표진행비교급상관연구。결과수술전후환자LL(술전P=0.032＜0.05，술후P=0.019＜0.05)、PT(술전P=0.046＜0.05，술후P=0.008＜0.05)、CSVL(술전P=0.046＜0.05，술후P=0.020＜0.05)여ODI평분차이유통계학의의。수술전후Cobb(술전P=0.342＞0.05，술후P=0.741＞0.05)、nash-moe(술전P=0.433＞0.05，술후P=0.227＞0.05)여ODI평분차이무통계학의의。결론장절단고정가중건척주삼유서렬，관상면중건목적위정체평형，술전평형량호시교형솔불의과고。장절단융합재규정척주측만곡솔화정체실형비단절단융합경호，대우엄중적Cobb각선전성반탈위，응선택장절단융합이최대한도지감소상린절단병변。
Objective To compare the effect of long and short segment fixation for degenerative scoliosis on spinal 3-dimensional balance. Methods Thirty patients who underwent spinal surgery in our hospital from June 2005 to January 2012 were included in this retrospective study. They were divided into long segment fusion fixation group (n=18) and short segment fusion fixation group (n=12). The lumbar Cobb angle, lumbar lordosis(LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope (SS), sagittal vertical axis(SVA),central sacral vertical line distance (CSVL), nash-moe vertebral rotation grading, and Oswestry (ODI) score were compared between the two groups before and after operation. Results A significant difference was found between LL, PT, CSVL and ODI score before and after operation(P <0.05). However, no significant difference was observed between Cobb angle, nash-moe grading and ODI score before and after operation (P > 0.05). Conclusion Long segment fusion fixation can reconstruct the spinal three-dimensional sequence. The purpose to reconstruct coronal surface is to achieve its whole balance. The orthopedic rate should not be excessively high for those with a good preoperative balance. The effect of long segment fusion fixation is better than that of short segment fusion fixation on scoliosis curvature and overall imbalance. Long segment fusion fixation should thus be selected for those with severe rotatory subluxation Cobb angle in order to minimize adjacent segment lesions.