Zhang Wen-Hong, Yu Yang, Li Hong, Liu Fang
Hospital Department of Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China.
Department of Medical Imaging, Jiangyin Hospital of Traditional Chinese Medicine, Jiangyin 214400, Jiangsu, China.
Zhongguo Gu Shang. 2023 Sep 25;36(9):827-32. doi: 10.12200/j.issn.1003-0034.2023.09.007.
To explore the trend of changes in the parameters of the spine-pelvic sagittal plane before and after surgery in patients with double-segment lumbar spondylolisthesis (LSL) and to evaluate the value of the surgical effect.
A retrospective analysis of 95 double-segment lumbar spondylolisthesis patients treated with posterior lumbar interbody fusion from October 2019 to October 2020 were analyzed, including 31 males and 64 females;age ranging from 41 to 63 years old, with an average of (52.10±4.35) years old;degree of lesion, 47 patients with gradeⅠand 48 patients with gradeⅡ. The surgical efficacy was evaluated according to the Oswestry dysfunction index(ODI) improvement rate at 3 months after operation. ODI improvement rate ≥50% was considered good, and <50% was considered bad. Ninety-five patients were divided into good curative effect group (74 cases) and poor curative effect group (21 cases) according to surgical curative effect. The clinical data, such as gender, age, body mass index, course of disease, degree of disease, operation time, intraoperative blood loss, and comorbidities were compared between two groups were compared. The parameters of spine pelvis sagittal plane were observed before and 3 months after operation, including spine sacral angle (SSA), T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Clinical symptoms were evaluated using visual analogue scale (VAS) and ODI. The correlation between the changes of spine pelvis sagittal plane parameters and the changes of VAS and ODI before and after surgery were analyzed, and the value of spine pelvis sagittal plane parameters in evaluating the surgical efficacy of patients with double level lumbar spondylolisthesis at 3 months after surgery was evaluated.
The courses of disease and surgical time in the group with poor efficacy were longer than those in the group with good efficacy, and the degree of lesion was higher in the group with poor efficacy (<0.05). The SSA, TPA, LL, and SS of the group with good efficacy were higher than those of the group with poor efficacy before and 3 months after surgery, while the PT was lower than that of the group with poor efficacy (<0.05). The changes in SSA, TPA, LL, PT, and SS before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (<0.05). The VAS and ODI of both groups were lower at 3 months after surgery than before, and the group with good efficacy was lower(<0.05). The changes in VAS and ODI before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (<0.05). The changes in SSA, TPA, LL, PT, SS before and after surgery were positively correlated with the changes in VAS and ODI (<0.05). Three months after surgery, SSA, TPA, LL, PT, and SS were used to evaluate the surgical efficacy of patients with dual level lumbar spondylolisthesis. The area under the curve (AUC) was 0.868, 0.797, 0.875, 0.822, and 0.853, respectively. The combined evaluation of all indicators resulted in the highest AUC, 0.927, and the best sensitivity and specificity were 90.50% and 91.89%, respectively.
The spine pelvis sagittal plane parameters SSA, TPA, LL, and SS of patients with double level lumbar spondylolisthesis before and after surgery show an upward trend;PT shows a downward trend;PI do not change significantly. And the changes of SSA, TPA, LL, SS, and PT are closely related to the patient's pain level and the improvement of lumbar function, which can be used as parameters to evaluate the surgical efficacy.
探讨双节段腰椎滑脱（LSL）患者手术前后脊柱骨盆矢状面参数的变化趋势，并评估手术效果的价值。
回顾性分析2019年10月至2020年10月采用后路腰椎椎间融合术治疗的95例双节段腰椎滑脱患者，其中男性31例，女性64例；年龄41～63岁，平均（52.10±4.35）岁；病变程度，Ⅰ度47例，Ⅱ度48例。根据术后3个月的Oswestry功能障碍指数（ODI）改善率评估手术疗效。ODI改善率≥50%为良好，＜50%为差。根据手术疗效将95例患者分为疗效良好组（74例）和疗效差组（21例）。比较两组患者的性别、年龄、体重指数、病程、疾病程度、手术时间、术中出血量及合并症等临床资料。观察手术前后脊柱骨盆矢状面参数，包括脊柱骶骨角（SSA）、T1骨盆角（TPA）、腰椎前凸（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）。采用视觉模拟评分法（VAS）和ODI评估临床症状。分析手术前后脊柱骨盆矢状面参数变化与VAS和ODI变化的相关性，评估脊柱骨盆矢状面参数在双节段腰椎滑脱患者术后3个月评估手术疗效中的价值。
疗效差组的病程和手术时间长于疗效良好组，疗效差组的病变程度高于疗效良好组（＜0.05）。疗效良好组术前及术后3个月的SSA、TPA、LL和SS均高于疗效差组，而PT低于疗效差组（＜0.05）。疗效良好组手术前后SSA、TPA、LL、PT和SS的变化大于疗效差组（＜0.05）。两组术后3个月的VAS和ODI均低于术前，且疗效良好组更低（＜0.05）。疗效良好组手术前后VAS和ODI的变化大于疗效差组（＜0.05）。手术前后SSA、TPA、LL、PT、SS的变化与VAS和ODI的变化呈正相关（＜0.05）。术后3个月，采用SSA、TPA、LL、PT和SS评估双节段腰椎滑脱患者的手术疗效。曲线下面积（AUC）分别为0.868、0.797、0.875、0.822和0.853。所有指标联合评估的AUC最高，为0.927，最佳敏感性和特异性分别为90.50%和91.89%。
双节段腰椎滑脱患者手术前后脊柱骨盆矢状面参数SSA、TPA、LL和SS呈上升趋势；PT呈下降趋势；PI变化不明显。且SSA、TPA、LL、SS和PT的变化与患者疼痛程度及腰椎功能改善密切相关，可作为评估手术疗效的参数。
