CAJ | 학술논문

目的评估术后即刻骨盆投射角与腰椎前凸角之差(PI-LL)是否重建至正常范围与退变性脊柱侧凸患者远期随访中矢状位矫正丢失、内固定失败及生活质量的关系.方法收集2005年1月至2011年12月在南京大学医学院附属鼓楼医院接受退变性脊柱侧凸矫形术的62例患者的临床资料,男性11例,女性51例,平均年龄(57±10)岁,随访时间均＞2年(平均4.2年).测量术前、术后及末次随访时患者矢状位参数并计算PI-LL.根据术后即刻PI-LL是否重建至-9°～9°将患者分为两组,并收集末次随访时患者的生活质量量表(包括视觉模拟评分和Oswestry功能障碍指数).分别使用独立样本t检验和x2检验比较两组患者在末次随访时矢状位矫正丢失、生活质量以及内固定失败发生率的差异.结果在随访过程中,两组患者间各影像学参数矫正丢失的差异均无统计学意义(P＞0.05).正常组患者6.7％(2/30)出现内固定失败,非正常组患者15.6％(5/32)出现断棒,两组间内同定失败发生率差异有统计学意义(x2=21.85,P=0.012).末次随访时,两组患者的生活质量差异有统计学意义,正常组患者的视觉模拟评分低于非正常组患者(F=0.089,P=0.024).结论 PI-LL重建不佳与患者远期生活质量降低、内固定失败风险增加有关,而与远期矫正丢失无关.
목적 평고술후즉각골분투사각여요추전철각지차(PI-LL)시부중건지정상범위여퇴변성척주측철환자원기수방중시상위교정주실、내고정실패급생활질량적관계.방법 수집2005년1월지2011년12월재남경대학의학원부속고루의원접수퇴변성척주측철교형술적62례환자적림상자료,남성11례,녀성51례,평균년령(57±10)세,수방시간균＞2년(평균4.2년).측량술전、술후급말차수방시환자시상위삼수병계산PI-LL.근거술후즉각PI-LL시부중건지-9°～9°장환자분위량조,병수집말차수방시환자적생활질량량표(포괄시각모의평분화Oswestry공능장애지수).분별사용독립양본t검험화x2검험비교량조환자재말차수방시시상위교정주실、생활질량이급내고정실패발생솔적차이.결과 재수방과정중,량조환자간각영상학삼수교정주실적차이균무통계학의의(P＞0.05).정상조환자6.7％(2/30)출현내고정실패,비정상조환자15.6％(5/32)출현단봉,량조간내동정실패발생솔차이유통계학의의(x2=21.85,P=0.012).말차수방시,량조환자적생활질량차이유통계학의의,정상조환자적시각모의평분저우비정상조환자(F=0.089,P=0.024).결론 PI-LL중건불가여환자원기생활질량강저、내고정실패풍험증가유관,이여원기교정주실무관.
Objective To evaluate the role that post-operative difference value of pelvic incidence and lumbar lordosis (PI-LL) played on loss of correction,implant failure and health-related quality of life during follow-up in degenerative scoliosis patients.Methods Retrospective review of 62 patients (average age (57 ± 10) years,11 male and 51 female patients) with degenerative scoliosis who underwent one stage posterior surgical instrumentation in the affiliated Drum Tower Hospital of Nanjing University Medical School from January 2005 to December 2011.The mean follow-up duration was 4.2 years.Long-cassette standing upright sagittal radiographs were obtained before and after operation and at the last follow-up.At the last follow-up,visual analogue scale and Oswestry disability index were collected.Based on post-operative PI-LL,patients were divided into two groups:group A (-9° ＜ post-operative PI-LL ＜9°) and group B (post-operative PI-LL ＜-9° or post-operative PI-LL ＞ 9°).Independent t test and x2 test were performed for statistical analysis.For all statistical analysis,the level of significance was set at P ＜ 0.05.Results No difference was observed in terms of loss of correction between two groups during follow-up.More implant failure were observed in group B (15.63％ vs.6.7％,x2 =21.85,P =0.012).In addition,patients with better PI-LL matching came with better visual analogue scale (3.9-2.4 vs.5.2 ± 3.3,F =0.089,P =0.024).Conclusion Worse quality of life and increased risk for implant failure during follow-up may be related to mismatched PI-LL.