腰骶部骨折后慢性下腰痛与矢状面和额状面椎体失平衡相关。
Chronic low back pain after lumbosacral fracture due to sagittal and frontal vertebral imbalance.
机构信息
Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Michallon, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 09, France.
Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Michallon, centre hospitalier universitaire Grenoble-Alpes, boulevard de la Chantourne, CS10217, 38043 Grenoble cedex 09, France.
出版信息
Orthop Traumatol Surg Res. 2017 Jun;103(4):523-526. doi: 10.1016/j.otsr.2017.01.013. Epub 2017 Mar 19.
PROBLEM AND HYPOTHESIS
Over time, some patients with unilateral or bilateral lumbosacral injuries experience chronic low back pain. We studied the sagittal and frontal balance in a population with these injuries to determine whether mismatch in the pelvic and lumbar angles are associated with chronic low back pain.
PATIENTS AND METHODS
Patients with posterior pelvic ring fractures (Tile C1, C2, C3 and A3.3) that had healed were included. Foreign patients and those with an associated spinal or acetabular fracture or nonunion were excluded. The review consisted of subjective questionnaires, a clinical examination, and standing A/P and lateral stereoradiographic views. The pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), measured lumbar lordosis (LLm), T9 sagittal offset, leg discrepancy (LD) and lateral curvature (LC). The expected lumbar lordosis (LLe) was calculated using the formula LLe=PI+9°. We defined lumbopelvic mismatch (LPM) as the difference between LLm and LLe being equal or greater than 25% of LLe.
RESULTS
Fifteen patients were reviewed after an average follow-up of 8.8 years [5.4-15]. There were four Tile C1, five Tile C2, five Tile C3 and one Tile A3.3 fracture. Ten of the 15 patients had low back pain. The mean angles were: LLm 49.6° and LLe 71.9° (P=0.002), PT 21.3°, SS 44.1°, PI 62.9° in patients with low back pain and LLm 57.4° and LLe 63.2° (P=0.55), PT 13°, SS 43.1°, PI 54.2° in those without. LPM was present in 9 patients, 8 of who had low back pain (P=0.02). Six patients, all of whom had low back pain, had a mean LC of 7.5° [4.5-23] (P=0.02). The mean LD was 0.77cm.
DISCUSSION
The findings of this small study suggest that patients who experience low back pain after their posterior arch of the pelvic ring fracture has healed, have a lumbopelvic mismatch. Early treatment of these patients should aim to reestablish the anatomy of the pelvic base relative to the frontal and sagittal balance.
LEVEL OF EVIDENCE
IV.
问题与假设
随着时间的推移，一些单侧或双侧腰骶部损伤的患者会出现慢性下腰痛。我们研究了这群患者的矢状面和额状面平衡，以确定骨盆和腰椎角度的不匹配是否与慢性下腰痛有关。
患者与骨盆后环骨折（Tile C1、C2、C3 和 A3.3）已愈合，包括在内。排除了外国患者和伴有脊柱或髋臼骨折或不愈合的患者。回顾包括主观问卷、临床检查以及站立前后位和侧位立体射线照片。骨盆倾斜度（PT）、骶骨倾斜度（SS）、骨盆入射角（PI）、测量的腰椎前凸（LLm）、T9 矢状面偏移、下肢差异（LD）和侧凸（LC）。使用公式 LLe=PI+9°计算预期的腰椎前凸（LLe）。我们将腰椎骨盆不匹配（LPM）定义为 LLm 与 LLe 之间的差异等于或大于 LLe 的 25%。
结果
15 名患者平均随访 8.8 年后进行了复查[5.4-15]。有 4 例 Tile C1、5 例 Tile C2、5 例 Tile C3 和 1 例 Tile A3.3 骨折。15 名患者中有 10 名有下腰痛。平均角度为：腰痛患者的 LLm 为 49.6°，LLe 为 71.9°（P=0.002），PT 为 21.3°，SS 为 44.1°，PI 为 62.9°，无腰痛患者的 LLm 为 57.4°，LLe 为 63.2°（P=0.55），PT 为 13°，SS 为 43.1°，PI 为 54.2°。9 名患者存在 LPM，其中 8 名有腰痛（P=0.02）。6 名患者均有腰痛，平均 LC 为 7.5°[4.5-23]（P=0.02）。平均 LD 为 0.77cm。
讨论
这项小型研究的结果表明，骨盆后环骨折愈合后出现下腰痛的患者存在腰椎骨盆不匹配。这些患者的早期治疗应旨在重建骨盆基底相对于额状面和矢状面平衡的解剖结构。
证据水平
IV。
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