轻度峡部裂性腰椎滑脱症融合前后脊柱-骨盆矢状位参数及临床疗效分析_《中国修复重建外科杂志》

作者：

李亮 , 隋海涛 , 于学忠 , 姜保恩

东营市人民医院创伤骨科（山东东营，257091）;

关键词：

峡部裂性腰椎滑脱症脊柱-骨盆参数矢状位平衡后路腰椎椎体间融合

DOI：

10.7507/1002-1892.20130291

视频：

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目的探讨经后路腰椎椎间Cage融合术加椎弓根固定术治疗轻度峡部裂性腰椎滑脱症手术前后脊柱-骨盆矢状位参数变化及其与手术疗效的关系。方法回顾分析2009年10月－2011年10月经后路腰椎椎间Cage融合术加椎弓根固定术治疗的30例轻度峡部裂性腰椎滑脱症患者临床资料。男14例，女16例；年龄48～67岁，平均56.7岁。术前及末次随访时摄站立位脊柱全长正、侧位X线片，测量滑脱相关参数[滑移百分数（percentage of slipping，PS）、椎间隙高度、滑脱角（angle of slip，AS）]，脊柱相关参数[胸椎后凸角（thoracic kyphosis，TK）、胸腰联合角（thoracolumbar junction，TLJ）、C7矢状位平衡（sagittal vertical axis，SVA）、腰椎前凸角（lumbar lordosis，LL）、脊柱-骨盆角（spino-sacral angle，SSA）]和骨盆相关参数[骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）、骨盆入射角（pelvic incidence，PI）]；记录患者手术前后Oswestry功能障碍指数（ODI）评分。分析手术前后影像学参数以及ODI评分变化，并采用Pearson相关分析影像学参数及功能评分变化值间的相关性。结果患者术后滑脱相关参数及ODI评分与术前比较差异均有统计学意义（P lt; 0.05）；脊柱、骨盆相关参数中，除TLJ和TK外，其余各参数手术前后比较差异均有统计学意义（P lt; 0.05）。SVA变化值与PS、PI、PT、LL、SS、AS、SSA及ODI变化值间存在线性相关；SSA变化值与PS、PI、LL、SS、AS、PT及ODI变化值间存在线性相关。结论经后路腰椎椎间Cage融合术加椎弓根固定可明显改善轻度峡部裂性腰椎滑脱症患者的脊柱-骨盆矢状位平衡状态，SVA及SSA重建能获得更好的手术疗效。

引用本文： 李亮,隋海涛,于学忠,姜保恩. 轻度峡部裂性腰椎滑脱症融合前后脊柱-骨盆矢状位参数及临床疗效分析. 中国修复重建外科杂志, 2013, 27(11): 1338-1344. doi: 10.7507/1002-1892.20130291 复制

1.	Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2.	Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3.	Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4.	李鹏飞, 贾楠, 靳宪辉, 等. 椎间植骨粒体积对腰椎后路滑脱复位植骨融合内固定术后融合效果的影响. 中国修复重建外科杂志, 2013, 27(6): 696-702.
5.	Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6.	海涌, 赵会, 邵楠, 等. 腰椎融合术后下腰痛与腰椎矢状位序列的关系. 中华医学杂志, 2013, 93(15): 1129-1132.
7.	Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8.	Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9.	Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10.	Bourghli A, Aunoble S, Reebye O, et al. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J, 2011, 20 Suppl 5: 663-668.
11.	贾俊峰, 赵杰, 陈志明, 等. 腰椎峡部裂型滑脱症矢状位参数分析. 中国矫形外科杂志, 2007, 15(11): 850-852.
12.	Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13.	Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14.	Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15.	刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4): 307-311.
16.	Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17.	Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18.	Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19.	Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20.	Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21.	Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis -spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
22.	Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23.	Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24.	Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25.	Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26.	Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27.	Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28.	Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29.	徐宝山, 马信龙. 脊柱骨盆矢状力线在脊柱疾患中的意义. 中华骨科杂志, 2012, 32(1): 80-85.
30.	Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31.	Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32.	Hakało J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33.	Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34.	Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35.	Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36.	Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37.	Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

1. Hresko MT, Hirschfeld R, Buerk AA, et al. The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment. J Pediatr Orthop, 2009, 29(2): 157-162.
2. Park SJ, Lee CS, Chung SS, et al. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis. Neurosurgery, 2011, 68(2 Suppl Operative): 355-363.
3. Carreon LY, Glassman SD, Howard J. Fusion and nonsurgical treatment for symptomatic lumbar degenerative disease: a systematic review of Oswestry Disability Index and MOS Short Form-36 outcomes. Spine J, 2008, 8(5): 747-755.
4. 李鹏飞, 贾楠, 靳宪辉, 等. 椎间植骨粒体积对腰椎后路滑脱复位植骨融合内固定术后融合效果的影响. 中国修复重建外科杂志, 2013, 27(6): 696-702.
5. Le Huec JC, Leijssen P, Duarte M, et al. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique. Eur Spine J, 2011, 20 Suppl 5: 669-680.
6. 海涌, 赵会, 邵楠, 等. 腰椎融合术后下腰痛与腰椎矢状位序列的关系. 中华医学杂志, 2013, 93(15): 1129-1132.
7. Lafage V, Schwab F, Vira S, et al. Does vertebral level of pedicle subtraction osteotomy correlate with degree of spinopelvic parameter correction? J Neurosurg Spine, 2011, 14(2): 184-191.
8. Sengupta DK, Herkowitz HN. Degenerative spondylolisthesis: Review of current trends and controversies. Spine (Phila Pa 1976), 2005, 30(6): S71-81.
9. Miyazaki M, Hymanson HJ, Morshita Y, et al. Kinematic analysis of the relationship between sagittal alignment and disc degeneration in the cervical spine. Spine (Phila Pa 1976), 2008, 33(22): E870-876.
10. Bourghli A, Aunoble S, Reebye O, et al. Correlation of clinical outcome and spinopelvic sagittal alignment after surgical treatment of low-grade isthmic spondylolisthesis. Eur Spine J, 2011, 20 Suppl 5: 663-668.
11. 贾俊峰, 赵杰, 陈志明, 等. 腰椎峡部裂型滑脱症矢状位参数分析. 中国矫形外科杂志, 2007, 15(11): 850-852.
12. Legaye J, Duval-Beaupère G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J, 1998, 7(2): 99-103.
13. Le Huec JC, Aunoble S, Philippe L, et al. Pelvic parameters: origin and significance. Eur Spine J, 2011, 20 Suppl 5: 564-571.
14. Lafage V, Schwab F, Skalli W, et al. Standing balance and sagittal plane spinal deformity: analysis of spinopelvic and gravity line parameters. Spine (Phila Pa 1976), 2008, 33(14): 1572-1578.
15. 刘勇, 刘臻, 朱锋, 等. 成人腰椎峡部裂性滑脱症与退变性滑脱症患者脊柱骨盆矢状面形态学研究. 中国脊柱脊髓杂志, 2013, 23(4): 307-311.
16. Labelle H, Roussouly P, Chopin D, et al. Spino-pelvic alignment after surgical correction for developmental spondylolisthesis. Eur Spine J, 2008, 17(9): 1170-1176.
17. Roussouly P, Gollogly S, Berthonnaud E, et al. Classification of the normal variation in the sagittal alignment of the human lumbar spine and pelvis in the standing position. Spine (Phila Pa 1976), 2005, 30(3): 346-353.
18. Labelle H, Mac-Thiong JM, Roussouly P. Spino-pelvic sagittal balance of spondylolisthesis: a review and classification. Eur Spine J, 2011, 20 Suppl 5: S641-646.
19. Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
20. Schwab F, Lafage V, Patel A, et al. Sagittal plane considerations and the pelvis in the adult patient. Spine (Phila Pa 1976), 2009, 34(17): 1828-1833.
21. Barrey C, Jund J, Noseda O, et al. Sagittal balance of the pelvis -spine complex and lumbar degenerative diseases: a comparative study about 85 cases. Eur Spine J, 2007, 16(9): 1459-1467.
22. Funao H, Tsuji T, Hosogane N, et al. Comparativestudy of spinopelvic sagittal alignment between patients with and without degenerative spondylolisthesis. Eur Spine J, 2012, 21(11): 2181-2187.
23. Roussouly P, Gollogly S, Noseda O, et al. The vertical projection of the sum of the ground reactive forces of a standing patient is not the same as the C7 plumb line: a radiographic study of the sagittal alignment of 153 asymptomatic volunteers. Spine (Phila Pa 1976), 2006, 31(11): E320-325.
24. Lafage V, Schwab F, Patel A, et al. Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine (Phila Pa 1976), 2009, 34(17): E599-606.
25. Mac-Thiong JM, Roussouly P, Berthonnaud E, et al. Sagittal parameters of global spinal balance: normative values from a prospective cohort of seven hundred nine Caucasian asymptomatic adults. Spine (Phila Pa 1976), 2010, 35(22): E1193-1198.
26. Glassman S, Berven S, Bridwell K, et al. Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine (Phila Pa 1976), 2005, 30(6): 682-688.
27. Kim MK, Lee S, Kim E, et al. The impact of sagittal balance on clinical results after posterior interbody fusion for patients with degenerative spondylolisthesis: A Pilot study. BMC Musculoskelet Disord, 2011, 12: 69.
28. Chang KW, Leng X, Zhao W, et al. Quality control of reconstructed sagittal balance for sagittal imbalance. Spine (Phila Pa 1976), 2011, 36(3): E186-197.
29. 徐宝山, 马信龙. 脊柱骨盆矢状力线在脊柱疾患中的意义. 中华骨科杂志, 2012, 32(1): 80-85.
30. Kuntz C 4th, Levin LS, Ondra SL, et al. Neutral upright sagittal spinal alignment from the occiput to the pelvis in asymptomatic adults: a review and resynthesis of the literature. J Neurosurg Spine, 2007, 6(2): 104-112.
31. Mac-Thiong JM, Duong L, Parent S, et al. Reliability of the Spinal Deformity Study Group classification of lumbosacral spondylolisthesis. Spine (Phila Pa 1976), 2012, 37(2): E95-102.
32. Hakało J, Wroński J. The role of reduction in operative treatment of spondylolytic spondylolisthesis. Neurol Neurochir Pol, 2008, 42(4): 345-352.
33. Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis beforeand after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
34. Berthonnaud E, Dimnet J, Roussouly P, et al. Analysis of the sagittal spine and pelvis using shape and orientation parameters. J Spinal Disord Tech, 2005, 18(1): 40-47.
35. Vialle R, Ilharreborde B, Dauzac C, et al. Is there asagittal imbalanceof the spine in isthmic: spondylolisthesis? A correlation study. Eur Spine J, 2007, 16(10): 1641-1649.
36. Lee JH, Kim KT, Suk KS, et al. Analysis of spinapelvic parameters in lumbar degenerative kyphosis: correlation with spinal stenosis and spondylolisthesis. Spine (Phila Pa 1976), 2010, 35(24): E1386-1391.
37. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.

《中国修复重建外科杂志》

轻度峡部裂性腰椎滑脱症融合前后脊柱-骨盆矢状位参数及临床疗效分析

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《中国修复重建外科杂志》

轻度峡部裂性腰椎滑脱症融合前后脊柱-骨盆矢状位参数及临床疗效分析

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