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目的 :评估手术复位对儿童L5发育不良性重度滑脱患者脊柱-骨盆矢状位序列的影响。方法:回顾性分析13例行手术复位治疗的儿童L5发育不良性重度滑脱患者,其中男2例,女11例。均行减压复位内固定融合术。手术时年龄11.5±2.4岁(7~15岁)。采用配对样本t检验比较术前、末次随访时的滑脱程度(slip degree)、腰椎前凸角(lumbar lordosis,LL)、Boxall滑脱角(Boxall′s slip angle,BSA)、SDSG发育不良性腰骶角(Spinal Deformity Study Group dysplastic lumbosacral angle,SDSG-dys LSA)、骨盆投射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)的差异,评估手术复位后脊柱-骨盆矢状位序列的变化。结果:随访20.6±21.9个月(3~64个月),滑脱程度由术前的(76.01±15.65)%改善至末次随访时的(17.57±16.64)%(P<0.01),滑脱复位程度为(58.44±16.31)%,其中4例Ⅲ度滑脱患者完全复位。11例患者行S1上终板拱顶样部分切除,平均切除程度为(30.16±14.54)%。术前、末次随访时的LL分别为74.75°±18.11°、57.77°±14.83°,BSA分别为48.98°±16.01°、19.56°±18.70°,SDSG-dys LSA分别为19.78°±20.19°、-1.72°±19.04°,SS分别为28.68°±23.21°、41.13°±15.67°,末次随访时均较术前有显著性改变(P<0.05);PI分别为65.64°±19.88°、73.20°±18.85°,PT分别为36.88°±11.68°、32.03°±11.76°,末次随访时较术前无显著性改变(P>0.05)。C7铅垂线距骶骨后上角距离(sagittal vertical axis,SVA)较术前减小。末次随访时10例后倾型骨盆患者中2例(20%)转变为平衡型骨盆。结论:手术复位可改善儿童L5发育不良性重度滑脱患者脊柱-骨盆矢状位序列,矫正腰骶部后凸畸形,改善骶骨-骨盆矢状位序列。
PURPOSE: To evaluate the effect of surgical reduction on the spine-pelvic sagittal sequence in pediatric patients with dysplastic L5 dysplasia. Methods: Thirteen children with L5 dysplasia and severe spondylolisthesis treated by surgical reduction were retrospectively analyzed, including 2 males and 11 females. All patients underwent decompression and reduction internal fixation fusion. The age of surgery 11.5 ± 2.4 years (7 to 15 years old). The paired sample t-test was used to compare the preoperative and final follow-up degrees of slip, lumbar lordosis (LL), Boxall’s slip angle (BSA), SDSG dysplasia lumbosacral Spinal Deformity Study Group dysplastic lumbosacral angle (SDSG-dys LSA), pelvic pelvis incidence (PI), pelvic tilt (PT) and sacral slope (SS) Changes of spine - pelvis sagittal sequence after reduction. Results: The follow-up ranged from 20.6 ± 21.9 months (range 3 to 64 months). The degree of slippage improved from 76.01 ± 15.65% preoperatively to 17.57 ± 16.64% at the last follow-up (P <0.01) (58.44 ± 16.31)%, of which 4 patients with Ⅲ degree slippage completely reset. In 11 patients, the vascularization of the upper end of S1 was partially resected, the average extent of resection was (30.16 ± 14.54)%. The preoperative and postoperative follow-up LL were 74.75 ° ± 18.11 ° and 57.77 ° ± 14.83 °, respectively. The BSA values were 48.98 ° ± 16.01 ° and 19.56 ° ± 18.70 °, respectively, and the SDSG-dys-LSAs were 19.78 ° ± 20.19 °, 1.72 ° ± 19.04 ° and SS were 28.68 ° ± 23.21 ° and 41.13 ° ± 15.67 °, respectively, with significant changes at the last follow-up (P <0.05), and PIs were 65.64 ° ± 19.88 ° and 73.20 ° ± 18.85 ° and PT were 36.88 ° ± 11.68 ° and 32.03 ° ± 11.76 ° respectively. There was no significant change at the last follow-up (P> 0.05). C7 vertical line from the sacral angle (sagittal vertical axis, SVA) decreased compared with preoperative. Two patients (20%) in the 10 posterior pelvic pelvis at the final follow-up were converted to a balanced pelvis. Conclusion: Surgical reduction can improve the spine-pelvis sagittal sequence in children with L5 dysplastic spondylolisthesis, correct the lumbosacral kyphosis, and improve the sacral-pelvic sagittal sequence.