Li Liang, Sui Haitao, Yu Xuezhong, Jiang Baoen
Department of Orthopaedics, Dongying People's Hospital, Dongying Shandong, 257091, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Nov;27(11):1338-44.
To investigate the effect of the sagittal alignment of the spine and pelvis after surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic lumbar spondylolisthesis, and to assess the effectiveness.
Between October 2009 and October 2011, 30 patients with low-grade isthmic spondylolisthesis underwent surgical posterior intervertebral fusion combined with pedicle screw fixation, and the clinical data were retrospectively reviewed. There were 14 males and 16 females with an average age of 56.7 years (range, 48-67 years). The pre- and post-operative radiographic parameters, such as percentage of slipping (PS), intervertebral space height, angle of slip (AS), thoracic kyphosis (TK), thoracolumbar junction angle (TLJ), sagittal vertical axis (SVA), lumbar lordosis (LL), spino-sacral angle (SSA), sacral slope (SS), pelvic tilt (PT), and pelvic incidence (PI) were measured. The functional evaluation was made using the Oswestry Disability Index (ODI). Pearson correlation were used to investigate the association between all parameters and ODI score.
PS, intervertebral space height, AS, and ODI were improved significantly compared withproperative ones (P < 0.05). Significant differences were found in the other parameters between pre- and post-operation (P < 0.05) except TLJ and TK. The alteration of SVA showed significant correlation with the changes of PS, PI, PT, LL, SS, AS, SSA, and ODI. The alteration of SSA showed significant correlation with the changes of PS, PI, LL, SS, AS, PT, and ODI.
Surgical posterior intervertebral fusion combined with pedicle screw fixation for low-grade isthmic spondylolisthesis can effectively improve and maintain the spinal sagittal parameters. SVA and SSA are adequate to evaluate pre-and post-operative balance. The good clinical outcome is closely related with the improved of SVA and SSA.
探讨后路椎间融合联合椎弓根螺钉内固定术治疗低度峡部裂型腰椎滑脱症后脊柱和骨盆矢状位排列的变化，并评估其疗效。
回顾性分析2009年10月至2011年10月间30例行后路椎间融合联合椎弓根螺钉内固定术治疗的低度峡部裂型腰椎滑脱症患者的临床资料。其中男性14例，女性16例，平均年龄56.7岁（48 - 67岁）。测量术前及术后的影像学参数，包括滑脱百分比（PS）、椎间隙高度、滑脱角（AS）、胸椎后凸角（TK）、胸腰段交界角（TLJ）、矢状垂直轴（SVA）、腰椎前凸角（LL）、脊柱 - 骶骨角（SSA）、骶骨倾斜角（SS）、骨盆倾斜角（PT）及骨盆入射角（PI）。采用Oswestry功能障碍指数（ODI）进行功能评估。采用Pearson相关性分析研究各参数与ODI评分之间的相关性。
与术前相比，PS、椎间隙高度、AS及ODI均有显著改善（P < 0.05）。除TLJ和TK外，其他参数术前与术后比较差异均有统计学意义（P < 0.05）。SVA的改变与PS、PI、PT、LL、SS、AS、SSA及ODI的变化呈显著相关。SSA的改变与PS、PI、LL、SS、AS、PT及ODI 的变化呈显著相关。
后路椎间融合联合椎弓根螺钉内固定术治疗低度峡部裂型腰椎滑脱症可有效改善并维持脊柱矢状位参数。SVA和SSA足以评估手术前后的平衡情况。良好的临床疗效与SVA和SSA的改善密切相关。
