Fei Han, Li Wei-Shi, Sun Zhuo-Ran, Jiang Shuai, Chen Zhong-Qiang
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Medicine (Baltimore). 2017 Aug;96(32):e7648. doi: 10.1097/MD.0000000000007648.
This study aimed to analyze the effect of patient positions on the lordosis and scoliosis of patients with degenerative lumbar scoliosis (DLS).Seventy-seven patients with DLS were retrospectively analyzed. We measured lordosis and Cobb's angle on preoperative upright x-rays and magnetic resonance imagings in supine position. The lordosis and scoliosis of surgical segments in intraoperative prone position were measured on intraoperative radiographs of 20 patients to compare with that in standing position. Paired t tests were performed to investigate the parameters of the sample.From standing to supine position the whole lordosis increased (29.2 ± 15.7 degree vs. 34.9 ± 11.2 degree), and the whole scoliosis decreased (24.3 ± 11.8 degree vs. 19.0 ± 10.5 degree); 53 of 77 (68.8%) cases had increased lordosis, and 67 of 77 (87%) cases had decreased scoliosis. The lordosis of surgical segments in standing position had no difference with that in intraoprerative prone position. But in changing from supine/standing position to intraoprerative prone position, the scoliosis of surgical segments decreased (14.7 ± 9.4 degree vs. 11.4 ± 7.0 degree; 19.0 ± 11.8 degree vs. 11.4 ± 7.0 degree, respectively), and 18 of 20 (90%) cases had decreased scoliosis in intraoperative prone position than that in standing position.Compared with standing position in DLS patients, supine position increased lordosis and reduced scoliosis, and intraoperative prone position reduced scoliosis significantly. When evaluating the severity of DLS and making preoperative surgical plans, lumbar lordosis in supine position should also be evaluated in addition to upright x-ray, and the effects of different positions should be taken into consideration to reduce deviation.
本研究旨在分析患者体位对退变性腰椎侧弯（DLS）患者腰椎前凸和脊柱侧弯的影响。对77例DLS患者进行回顾性分析。我们在术前站立位X线片和仰卧位磁共振成像上测量腰椎前凸和Cobb角。在20例患者的术中X线片上测量术中俯卧位时手术节段的腰椎前凸和脊柱侧弯，以与站立位时进行比较。采用配对t检验来研究样本参数。从站立位到仰卧位，整体腰椎前凸增加（29.2±15.7度 vs. 34.9±11.2度），整体脊柱侧弯减小（24.3±11.8度 vs. 19.0±10.5度）；77例中有53例（68.8%）腰椎前凸增加，77例中有67例（87%）脊柱侧弯减小。站立位时手术节段的腰椎前凸与术中俯卧位时无差异。但从仰卧位/站立位变为术中俯卧位时，手术节段的脊柱侧弯减小（分别为14.7±9.4度 vs. 11.4±7.0度；19.0±11.8度 vs. 11.4±7.0度），20例中有18例（90%）术中俯卧位时的脊柱侧弯比站立位时减小。与DLS患者的站立位相比，仰卧位增加了腰椎前凸并减少了脊柱侧弯，术中俯卧位显著减少了脊柱侧弯。在评估DLS的严重程度并制定术前手术计划时，除了站立位X线片外，还应评估仰卧位时的腰椎前凸，并考虑不同体位的影响以减少偏差。
