Yang Xi, Kong Qingquan, Song Yueming, Liu Limin, Li Tao, Gong Quan, Zeng Jiancheng, Liu Hao
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Jan;30(1):65-71.
To observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation.
Between January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method: the balanced pelvis subgroup (n = 14) and unbalanced pelvis subgroup (n = 11). The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively.
All patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P < 0.05), while the TK was significantly smaller than that of control group (P < 0.05). In the balanced pelvis subgroup, LSA, LL, and SVA at last follow-up significantly decreased while TK significantly increased when compared with preoperative ones (P < 0.05). In the unbalanced pelvis subgroup, LSA, PT, and SVA at last follow-up significantly decreased while SS, LL, and TK significantly increased when compared with preoperative ones (P < 0.05). The preoperative LSA and PT in the unbalanced pelvis subgroup were significantly greater, while SS, LL, and TK were significantly smaller than those of balanced pelvis subgroup (P < 0.05); while at last follow-up, significant differentce was found only in LSA between 2 subgroups (P < 0.05).
The LSA should be paid more attention in surgery to assure recovery of the sagittal balance because patients with high-grade L5 isthmic spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.
观察重度L5峡部裂性腰椎滑脱症患者的脊柱-骨盆矢状位对线特征，并分析术后矢状位对线的改变。
2009年1月至2014年6月，25例重度L5峡部裂性腰椎滑脱症患者接受了后路手术，对其临床资料进行回顾性分析作为研究组。其中男性14例，女性11例，平均年龄42.5岁（范围20 - 65岁）。平均病程6个月（范围3 - 12个月）。根据Meyerding评估系统，Ⅲ度15例，Ⅳ度10例。同时招募80名健康成年志愿者作为对照组。在术前和末次随访时的站立位全长侧位X线片上测量腰骶角（LSA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）、胸椎后凸角（TK）和矢状垂直轴（SVA）。并将研究组（术前参数）与对照组的这些参数进行比较。然后根据Hresko方法将研究组患者分为2个亚组：骨盆平衡亚组（n = 14）和骨盆失衡亚组（n = 11）。比较2个亚组之间的矢状位参数，并分别分析每个亚组术前和末次随访时矢状位参数的改变。
研究组所有患者平均随访18个月（范围6 - 48个月）。术后，12例患者的腰椎滑脱从Ⅲ度降至0度，3例降至Ⅰ度；6例患者从Ⅳ度降至0度，4例降至Ⅰ度。末次随访时所有患者均获得骨融合。研究组术前的PI、SS、PT和SVA显著大于对照组（P < 0.05），而TK显著小于对照组（P < 0.05）。在骨盆平衡亚组中，与术前相比，末次随访时LSA、LL和SVA显著降低，而TK显著增加（P < 0.05）。在骨盆失衡亚组中，与术前相比，末次随访时LSA、PT和SVA显著降低，而SS、LL和TK显著增加（P < 0.05）。骨盆失衡亚组术前的LSA和PT显著大于骨盆平衡亚组，而SS、LL和TK显著小于骨盆平衡亚组（P < 0.05）；而在末次随访时，2个亚组之间仅在LSA上存在显著差异（P < 0.05）。
重度L5峡部裂性腰椎滑脱症患者具有较大的PI、腰骶部后凸异常和矢状位失衡，手术中应更多关注LSA以确保矢状位平衡的恢复。
