| 摘要: |
| 目的 探讨单节段L4/5退行性腰椎滑脱症患者行腰椎后路椎间融合术治疗时完全复位对临床疗效及矢状位力线的影响。方法 纳入2015年1月至2018年1月于我院因L4/5腰椎退行性滑脱症行腰椎后路椎间融合术治疗的患者，根据术中是否对滑脱行完全复位随机选取完全复位者35例和部分复位者35例。对比分析两组患者术前一般资料、手术情况、影像学参数及临床疗效指标。结果 两组患者性别、年龄、BMI、滑脱程度，以及术前胸椎后凸角（TK）、腰椎前凸角（LL）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、矢状位偏移距（SVA）、疼痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分差异均无统计学意义（P均>0.05）。完全复位组患者术中出血量多于部分复位组［（230.1±67.6）mL vs （182.5±56.3）mL］，手术时间长于部分复位组［（176.4±35.2）min vs （152.6±23.4）min］，滑脱矫形率高于部分复位组［（89.5±10.2）% vs （30.5±20.5）%］，差异均有统计学意义（P均<0.001）。与术前相比，术后两组患者TK、PT、SVA均减小，LL均增大。术后3个月，完全复位组SVA小于部分复位组［（26.5±21.2）mm vs （34.5±24.6）mm，P=0.012］；末次随访时，完全复位组LL、PT和SVA均小于部分复位组［（45.3±5.9）° vs （48.2±6.3）°、（16.4±6.8）° vs （18.3±7.1）°、（26.8±23.2）mm vs （36.5±26.2）mm，P均<0.05］。末次随访时，完全复位组的VAS和ODI评分均小于部分复位组［（1.2±0.5）分vs（2.2±0.8）分、（14.5±4.5）分vs（20.9±6.4）分，P均<0.05］。结论 对于L4/5单节段退行性腰椎滑脱症患者而言，无论完全复位抑或部分复位均能取得较好的临床疗效。较之部分复位，完全复位的患者出血量相对较多、手术时间相对延长，但远期临床疗效较好，且能够保证更好的矢状位力线。 |
| 关键词: 退行性腰椎滑脱症 完全复位 矢状位 临床疗效 |
| DOI：10.16781/j.CN31-2187/R.20220472 |
| 投稿时间：2022-06-05修订日期：2022-08-26 |
| 基金项目:上海市自然科学基金（22ZR1476600），海军军医大学（第二军医大学）远航计划（18X3301）. |
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| Efficacy of complete reduction on single segment L4/5 degenerative lumbar spondylolisthesis |
| LU Chun-wen△,DU Shi-yao△,WANG Yong,WANG Liang-liang,CHANG Zhu,WANG Zhen-wei,XU Tian-ming* |
(Department of Orthopaedics, No. 905 Hospital of PLA Navy, Shanghai 200050, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To study the effect of complete reduction on the clinical efficacy and sagittal alignment of patients with single segment L4/5 degenerative lumbar spondylolisthesis undergoing posterior lumbar interbody fusion. Methods A total of 70 patients who underwent posterior lumbar interbody fusion for L4/5 lumbar degenerative spondylolisthesis in our hospital from Jan. 2015 to Jan. 2018 were included. They were divided into complete reduction group and partial reduction group, with 35 cases in each group. The general data, operation parameters, radiographical parameters and clinical efficacy of the 2 groups were analyzed. Results There were no significance in gender, age, body mass index, spondylolisthesis degree, or preoperative thoracic kyphosis (TK), lumbar lodorsis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), visual analogue scale (VAS) score, or Oswestry disability index (ODI) score between the 2 groups (all P>0.05). Compared with the partial reduction group, the complete reduction group had more intraoperative blood loss ([230.1±67.6] mL vs[182.5±56.3] mL), longer operative time ([176.4±35.2] min vs[152.6±23.4] min), and higher correction rate ([89.5±10.2]% vs[30.5±20.5]%) (all P<0.001). Compared with those before operation, TK, PT and SVA in the 2 groups were decreased, while LL was increased. At 3 months after operation, SVA in the complete reduction group was smaller than that in the partial reduction group ([26.5±21.2] mm vs[34.5±24.6] mm, P=0.012). At the last follow-up, LL, PT and SVA in the complete reduction group were smaller than those in the partial reduction group ([45.3±5.9] ° vs[48.2±6.3] °,[16.4±6.8] ° vs[18.3±7.1] °,[26.8±23.2] mm vs[36.5±26.2] mm, all P<0.05); and the VAS and ODI scores in the complete reduction group were lower than those in the partial reduction group (1.2±0.5 vs 2.2±0.8, 14.5±4.5 vs 20.9±6.4, both P<0.05). Conclusion As for patients with L4/5 single segment degenerative lumbar spondylolisthesis, either complete reduction or partial reduction can achieve better clinical efficacy. Compared with partial reduction, patients with complete reduction have more blood loss and longer operative time, but they have better long-term clinical efficacy and can restore a better sagittal profile. |
| Key words: degenerative lumbar spondylolisthesis complete reduction sagittal profile clinical efficacy |
