Banno Tomohiro, Hasegawa Tomohiko, Yamato Yu, Kobayashi Sho, Togawa Daisuke, Oe Shin, Mihara Yuki, Matsuyama Yukihiro
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Spine (Phila Pa 1976). 2016 Nov 1;41(21):1641-1648. doi: 10.1097/BRS.0000000000001608.
Retrospective review.
We investigated validity of T1 pelvic angle (TPA) for postoperative assessment and determined its target value for corrective scoliosis surgery.
TPA is a novel spinopelvic parameter accounting for both pelvic retroversion and trunk anteversion. As an angle, it is less affected by posture and correlates well with health-related quality of life in adult spinal deformity patients. According to our study in elderly volunteers, the threshold TPA value for disability (Oswestry Disability Index [ODI] score >20) was approximately 20°.
Seventy adult scoliosis patients (5 men and 65 women; mean age, 67.8 yr) who underwent spinal deformity surgeries and were followed up for at least 2 years postoperatively were studied. The following parameters based on whole-spine and pelvic radiography were assessed preoperatively, soon after operation, and 2 years postoperatively: C7-central sacral vertical line, TPA, sagittal vertical axis (SVA), pelvic tilt, and pelvic incidence minus lumbar lordosis. ODI and Scoliosis Research Society-22 scores were obtained preoperatively and 2 years postoperatively. Based on postoperative TPA, patients were divided into two groups: ≤20° (group G) and greater than 20° (group P).
TPA and SVA correlated with health-related quality of life. Two years postoperatively, TPA best correlated with ODI and Scoliosis Research Society-22 scores, although all parameters correlated with them, and TPA soon after operation best correlated with ODI scores 2 years postoperatively. Two years postoperatively, each parameter and ODI scores in group G were better than those in group P.
The correlation results showed that TPA appropriately assessed clinical outcomes following spinal deformity surgery. TPA assessed soon after operation correlated with ODI score 2 years postoperatively, and thus predicted prognosis. Because patients whose postoperative corrected TPA was 20° or lesser had better spinopelvic parameters and ODI scores 2 years postoperatively, TPA 20° or lesser was the proper target value for corrective surgery.
回顾性研究。
我们研究了T1骨盆角（TPA）用于术后评估的有效性，并确定其在脊柱侧凸矫正手术中的目标值。
TPA是一种新的脊柱骨盆参数，兼顾骨盆后倾和躯干前倾。作为一个角度参数，它受姿势影响较小，且与成人脊柱畸形患者的健康相关生活质量密切相关。根据我们对老年志愿者的研究，残疾（Oswestry残疾指数[ODI]评分>20）的TPA阈值约为20°。
对70例接受脊柱畸形手术且术后至少随访2年的成年脊柱侧凸患者（5例男性和65例女性；平均年龄67.8岁）进行研究。基于全脊柱和骨盆X线片，在术前、术后即刻和术后2年评估以下参数：C7-骶骨中央垂直线、TPA、矢状垂直轴（SVA）、骨盆倾斜度以及骨盆入射角减去腰椎前凸。术前和术后2年获取ODI和脊柱侧凸研究学会-22评分。根据术后TPA，将患者分为两组：≤20°（G组）和>20°（P组）。
TPA和SVA与健康相关生活质量相关。术后2年，TPA与ODI和脊柱侧凸研究学会-22评分的相关性最佳，尽管所有参数均与之相关，且术后即刻的TPA与术后2年的ODI评分相关性最佳。术后2年，G组的每个参数和ODI评分均优于P组。
相关性结果表明，TPA能恰当评估脊柱畸形手术后的临床结果。术后即刻评估的TPA与术后2年的ODI评分相关，因此可预测预后。由于术后矫正TPA为20°或更小的患者在术后2年具有更好的脊柱骨盆参数和ODI评分，所以20°或更小的TPA是矫正手术的合适目标值。
4级。
