CAJ | 학술논문

目的分析手术治疗老年人退变性腰椎滑脱症的临床疗效,并观察手术对骨盆参数及脊柱矢状面平衡的影响. 方法回顾性分析我科自2008年4月至2013年5月收治的老年退变性腰椎滑脱症患者20例临床资料,比较术前、术后腰或下肢视觉模拟评分法(VAS)评分和腰痛Oswestry功能障碍指数(ODI)评分及脊柱-骨盆影像学参数变化. 结果随访时间为24～84个月,平均35.7个月.20例患者均无断钉断棒现象发生,椎间骨性融合率达到100％.术前、术后腰痛、下肢痛VAS评分及ODI评分比较,差异有统计学意义(P＜0.01).手术前后脊柱全长X线片显示矢状面颈7铅垂线(C7VL)与骶骨后上缘距离变化差异无统计学意义(P＞0.05);术后腰椎前凸角明显增大[(53.3±7.6)°比(46.6±6.8)°,P＜0.05];骨盆指数术前、术后比较,差异无统计学意义[(50.2±10.1)°比(49.9±9.7)°,P＞0.05];骨盆倾斜角术后(10.7±2.1)°,较术前(15.7±2.5)°明显减小(P＜0.05);骶骨倾斜角术后(48.6±6.8)°,较术前(44.5±5.5)°明显增大(P＜0.05).按复位程度分为复位≥50％组和复位＜50％组,两组腰椎前凸角、骶骨倾斜角变化及临床症状改善比较,差异无统计学意义(P＞0.05). 结论手术治疗老年人退变性腰椎滑脱症可取得良好临床疗效,同时可维持全脊柱矢状面平衡,恢复腰椎的生理前凸,改善脊柱骨盆参数.
목적 분석수술치료노년인퇴변성요추활탈증적림상료효,병관찰수술대골분삼수급척주시상면평형적영향. 방법 회고성분석아과자2008년4월지2013년5월수치적노년퇴변성요추활탈증환자20례림상자료,비교술전、술후요혹하지시각모의평분법(VAS)평분화요통Oswestry공능장애지수(ODI)평분급척주-골분영상학삼수변화. 결과 수방시간위24～84개월,평균35.7개월.20례환자균무단정단봉현상발생,추간골성융합솔체도100％.술전、술후요통、하지통VAS평분급ODI평분비교,차이유통계학의의(P＜0.01).수술전후척주전장X선편현시시상면경7연수선(C7VL)여저골후상연거리변화차이무통계학의의(P＞0.05);술후요추전철각명현증대[(53.3±7.6)°비(46.6±6.8)°,P＜0.05];골분지수술전、술후비교,차이무통계학의의[(50.2±10.1)°비(49.9±9.7)°,P＞0.05];골분경사각술후(10.7±2.1)°,교술전(15.7±2.5)°명현감소(P＜0.05);저골경사각술후(48.6±6.8)°,교술전(44.5±5.5)°명현증대(P＜0.05).안복위정도분위복위≥50％조화복위＜50％조,량조요추전철각、저골경사각변화급림상증상개선비교,차이무통계학의의(P＞0.05). 결론 수술치료노년인퇴변성요추활탈증가취득량호림상료효,동시가유지전척주시상면평형,회복요추적생리전철,개선척주골분삼수.
Objective To analyze the effect of surgical treatment of degenerative lumbar spondylolisthesis on pelvic parameter and sagittal balance of the pelvis-spine complex in the elderly.Methods A retrospective analysis of degenerative lumbar spondylolisthesis in 20 cases was performed.The improvement in Visual Analogue Scale (VAS) of the waist or lower extremity pains and Oswestry disability index (ODI) for patients with low back pain, pelvic parameter and spinal sagittal balance, were assessed pre-and post-operatively.Results The average follow-up time was 35.7 months (24-84 months).No screw or plate broken was found in the 20 patients, with the inter-vertebral fusion rate of 100％.There were statistical differences in VAS and ODI scores of low back pain and leg pain before versus after treatment (P＜0.01 for both).But there was no statistical difference in the distance between C7 plumb line (C7PL) and upper edge of S1 vertebral body before versus after surgery (P＞0.05).The lumbar lordosis was increased post-operatively from (53.3 ±7.6)° to (46.6±6.8)° (P＜0.05).The pelvic index had no significant difference before versus after surgery [(50.2±10.1)° vs.(49.9±9.7)°, P＞0.05].The inclination of pelvis was decreased post-operatively from (10.7±2.1)° to (15.7±2.5)°.The sacral slope was increased post-operatively from (44.5±5.5)° to (48.6±6.8)°.Patients were grouped into ≥50％ restoration and ＜50％ restoration subgroup, and there were no significant differences in lumbar lordosis, changes in sacral slope and improvement of clinical symptom between the two subgroups (P＞0.05 for all).Conclusions The surgical treatment of degenerative lumbar spondylolisthesis has a good clinical effect in the elderly,that could maintain the spine global sagittal balance, recover the normal lumbar lordosis and improve the spinal pelvic parameters.