CAJ | 학술논문

目的探讨腰椎退行性疾患接受腰椎融合术后发生下腰痛和腰椎矢状位序列的关系.方法采取回顾性方法,对2008年1至12月在北京朝阳医院骨科因腰椎退行性疾患而接受腰椎融合手术的182例患者进行随访,将术后以及随访中仍存在腰痛、且随访在24个月的患者进行站立位腰椎侧位X片检查,测量站立位腰椎侧位X线片腰椎前凸的Cobb角度,并对腰痛的VAS评分及功能障碍ODI评分进行分析.对患者腰椎矢状位曲度与正常腰椎Cobb角的差值和腰痛评分的相关性进行统计学分析,探讨下腰痛的程度与腰椎矢状位Cobb角度大小之间的关系.结果本组42例术后出现不同程度的腰痛.其中男19例,女23例.平均年龄59.6(40 ～77)岁.测量腰椎矢状位Cobb角度:腰椎前凸角度术前平均值(40.2±10.3) (21 ～60)°；12个月随访平均值(40.1±10.6)(20 ～60)°；24个月随访平均值(40.8±10) (24 ～60)°.疼痛VAS评分:12个月随访平均值(29.4±11.5)(5～50)分；24个月随访平均值(27.6±11.7)(5～48)分.功能ODI评分:12个月随访平均值(15.1 ±5.4)(0 ～25)分；24个月随访平均值(13.9±5.2)(0～24分).腰椎前凸角度与基准数值差值:12个月随访平均值(19.9±10.6)(0～40)°；24个月随访平均值(19.2±10.0) (0～36)°.腰椎前凸角与正常值差值的大小和腰痛VAS评分之间的关系评价:12个月随访呈正相关(P＜0.01)；24个月随访呈正相关(P＜0.01)；腰椎前凸角与正常值差值的大小和ODI评分之间的关系评价:12个月随访呈正相关(P ＜0.01)；24个月随访呈正相关(P＜0.01).结论腰椎融合术后患者的下腰痛程度与矢状位前凸丢失程度存在紧密的联系,腰椎融合手术应该将重建腰椎前凸作为重要的目标之一.
목적 탐토요추퇴행성질환접수요추융합술후발생하요통화요추시상위서렬적관계.방법 채취회고성방법,대2008년1지12월재북경조양의원골과인요추퇴행성질환이접수요추융합수술적182례환자진행수방,장술후이급수방중잉존재요통、차수방재24개월적환자진행참립위요추측위X편검사,측량참립위요추측위X선편요추전철적Cobb각도,병대요통적VAS평분급공능장애ODI평분진행분석.대환자요추시상위곡도여정상요추Cobb각적차치화요통평분적상관성진행통계학분석,탐토하요통적정도여요추시상위Cobb각도대소지간적관계.결과 본조42례술후출현불동정도적요통.기중남19례,녀23례.평균년령59.6(40 ～77)세.측량요추시상위Cobb각도:요추전철각도술전평균치(40.2±10.3) (21 ～60)°；12개월수방평균치(40.1±10.6)(20 ～60)°；24개월수방평균치(40.8±10) (24 ～60)°.동통VAS평분:12개월수방평균치(29.4±11.5)(5～50)분；24개월수방평균치(27.6±11.7)(5～48)분.공능ODI평분:12개월수방평균치(15.1 ±5.4)(0 ～25)분；24개월수방평균치(13.9±5.2)(0～24분).요추전철각도여기준수치차치:12개월수방평균치(19.9±10.6)(0～40)°；24개월수방평균치(19.2±10.0) (0～36)°.요추전철각여정상치차치적대소화요통VAS평분지간적관계평개:12개월수방정정상관(P＜0.01)；24개월수방정정상관(P＜0.01)；요추전철각여정상치차치적대소화ODI평분지간적관계평개:12개월수방정정상관(P ＜0.01)；24개월수방정정상관(P＜0.01).결론 요추융합술후환자적하요통정도여시상위전철주실정도존재긴밀적련계,요추융합수술응해장중건요추전철작위중요적목표지일.
Objective To evaluate retrospectively the relationship between low back pain and changes of lumbar spine sagittal alignment after lumbar spine fusion.Methods During January-December 2008,a total of 182 consecutive patients with degenerative lumbar spine diseases underwent posterior lumbar interbody fusion (PLIF) and the follow-up period was over 24 months.Standing lumbar spine anterioposterior and lateral radiography were taken during the follow-up and the lumbar lordosis Cobb angles were measured on radiography.Pain degrees were assessed by visual analog scale (VAS) and Oswestry disability index (ODI).The relationship between the changes of Cobb angle and lumbar sagittal plane curve was analyzed by the SPSS software.Also the relationship between back pain degree and Cobb angle was examined.Results Among them,42 cases with postoperative back pain were followed up for 24 months.There were 19 males and 23 females with a mean age of 59.6 years (range:40-77).Lumbar spine sagittal Cobb angles were measured from radiographic images:lumbar lordosis angle:① mean angle at 12-month follow-up:40.1 ° ± 10.6°,range:20°-60° ; ② mean angle at 24-month follow-up:40.8° ± 10°,range:24°-60°.Back pain of 42 patients:VAS:① mean at 12-month follow-up:29.4 ± 11.5,range:5-50 ; ② mean at 24-month followup:27.6 ± 11.7,range:25-48.Lumbar spine function of 42 patients:ODI:① mean at 12-month follow-up:15.1 ±5.4,range:0-25 ;② mean at 24-month follow-up:13.9 ± 5.2,range:0-24.Difference between lumbar lordosis angle and standard score:① mean angle at 12-month follow-up:19.9° ± 10.6°,range:0°-40°; ② mean angle at 24-month follow-up:19.2° ± 10.0°,range:0°-36°.Angle difference versus back pain VAS:① at 12-month follow-up:P ＜ 0.001,positive correlation; ② 24-month follow-up:P ＜ 0.001,positive correlation; angle difference versus back pain ODI:① 12-month follow-up:P ＜ 0.001,positive correlation; ② 24-month follow-up:P ＜ 0.001,positive correlation.Conclusion There is a close relationship between back pain after fusion and loss of lumbar sagittal lordosis.And reconstruction of lumbar lordosis should be one important goal for lumbar fusion.