Liu Hui, Li Sibei, Wang Jiranru, Wang Taiping, Yang Hao, Li Zemin, Li Xiang, Zheng Zhaomin
*Department of Spine Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; and †Chengdu Second People's Hospital, Chengdu, China.
Spine (Phila Pa 1976). 2014 Dec 15;39(26 Spec No.):B52-9. doi: 10.1097/BRS.0000000000000500.
A retrospective and radiological study of degenerative spinal diseases.
To explore the changes in spinopelvic sagittal alignment after lumbar instrumentation and fusion of degenerative spinal diseases.
Efforts have been paid to clarify the ideal postoperative sagittal profile for degenerative spinal diseases. However, little has been published about the actual changes of sagittal alignment after lumbar lordosis reconstruction.
Radiographical analysis of 83 patients with spinal degeneration was performed by measuring sagittal parameters before and after operations. Comparative studies of sagittal parameters between short (1 level) and long (≥ 2 level) instrumentation and fusion were performed. Different variances (Δ) of these sagittal parameters before and after operations were calculated and compared. Correlative study and linear regression were performed to establish the relationship between variances.
No significant changes were shown in the short-fusion group postoperatively. In the long-fusion group, postoperative lumbar lordosis (LL) and sacral slope (SS) were significantly increased; pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis, and PT/SS were significantly decreased. Different variances of ΔLL, ΔSS, ΔPT, ΔSVA, Δ(pelvic incidence - LL), and ΔPT/SS were significantly greater in the long-fusion group than the short-fusion group. Close correlations were mainly shown among ΔLL, ΔPT, and ΔSVA. Linear regression equations could be developed (ΔPT = -0.185 × ΔLL - 7.299 and ΔSVA = -0.152ΔLL - 1.145).
In degenerative spinal diseases, long instrumentation and fusion (≥ 2 levels) provides more efficient LL reconstruction. PT, SS, and SVA improve corresponding to LL in a linear regression model. Linear regression equations could be developed and used to predict PT and SVA change after long instrumentation and fusion for LL reconstruction.
一项关于退行性脊柱疾病的回顾性影像学研究。
探讨退行性脊柱疾病行腰椎内固定融合术后脊柱骨盆矢状位排列的变化。
人们一直在努力明确退行性脊柱疾病理想的术后矢状位形态。然而，关于腰椎前凸重建后矢状位排列的实际变化，相关报道较少。
对83例脊柱退变患者进行影像学分析，测量手术前后的矢状位参数。对短节段（1个节段）和长节段（≥2个节段）内固定融合的矢状位参数进行对比研究。计算并比较这些矢状位参数手术前后的不同变化量（Δ）。进行相关性研究和线性回归分析以建立变化量之间的关系。
短节段融合组术后未见明显变化。长节段融合组术后腰椎前凸（LL）和骶骨倾斜角（SS）显著增加；骨盆倾斜角（PT）、矢状垂直轴（SVA）、骨盆入射角减去腰椎前凸以及PT/SS显著减小。长节段融合组的ΔLL、ΔSS、ΔPT、ΔSVA、Δ（骨盆入射角 - LL）和ΔPT/SS的不同变化量显著大于短节段融合组。ΔLL、ΔPT和ΔSVA之间主要呈现密切相关性。可建立线性回归方程（ΔPT = -0.185×ΔLL - 7.299以及ΔSVA = -0.152ΔLL - 1.145）。
在退行性脊柱疾病中，长节段内固定融合（≥2个节段）能更有效地重建腰椎前凸。在一个线性回归模型中，PT、SS和SVA随LL的改善而相应改善。可建立线性回归方程并用于预测长节段内固定融合重建腰椎前凸后PT和SVA的变化。
