腰椎融合术后症状性相邻节段退变风险的评估：来自一组接受翻修手术患者的分析
Estimating the risk for symptomatic adjacent segment degeneration after lumbar fusion: analysis from a cohort of patients undergoing revision surgery.
作者信息
Di Martino Alberto, Quattrocchi Carlo Cosimo, Scarciolla Laura, Papapietro Nicola, Beomonte Zobel Bruno, Denaro Vincenzo
机构信息
Department of Orthopaedics and Trauma Surgery, Center of Integrated Research, CIR, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 200, 00128, Rome, Italy,
出版信息
Eur Spine J. 2014 Oct;23 Suppl 6:693-8. doi: 10.1007/s00586-014-3551-0. Epub 2014 Sep 12.
PURPOSE
Aim of this study is to estimate the risk for symptomatic adjacent segment degeneration (ASD) and examine the association between spino-pelvic parameters and ASD.
METHODS
22 patients operated upon by instrumented lumbar or lumbosacral spinal fusion and re-operated upon for ASD were enrolled in the study. 83 consecutive patients with the same surgery and never re-operated upon were the controls. Pelvic incidence, sacral slope (SS), pelvic tilt (PT), and lumbar lordosis were calculated.
RESULTS
Patients with ASD had significantly lower SS (p = 0.005) and higher PT values (p < 0.001). Patients with SS <39° or PT >21°, were at higher risk for symptomatic ASD (relative risk 1.73 for SS and 3.663 for PT).
CONCLUSIONS
In patients re-operated upon for ASD, pelvic retroversion and hyperlordosis are the main mechanisms of compensation for the unbalanced spine. Patients with PT above 21° and SS below 39° are at higher risk for symptomatic ASD.
目的
本研究旨在评估症状性相邻节段退变（ASD）的风险，并研究脊柱-骨盆参数与ASD之间的关联。
方法
本研究纳入了22例行器械辅助腰椎或腰骶部脊柱融合手术并因ASD再次手术的患者。83例接受相同手术且从未再次手术的连续患者作为对照。计算骨盆入射角、骶骨倾斜角（SS）、骨盆倾斜角（PT）和腰椎前凸。
结果
ASD患者的SS显著更低（p = 0.005），PT值更高（p < 0.001）。SS < 39°或PT > 21°的患者出现症状性ASD的风险更高（SS的相对风险为1.73，PT的相对风险为3.663）。
结论
在因ASD再次手术的患者中，骨盆后倾和腰椎前凸增加是脊柱失衡的主要代偿机制。PT高于21°且SS低于39°的患者出现症状性ASD的风险更高。
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