Optimal Pelvic Incidence Minus Lumbar Lordosis Mismatch after Long Posterior Instrumentation and Fusion for Adult Degenerative Scoliosis
Optimal Pelvic Incidence Minus Lumbar Lordosis Mismatch after Long Posterior Instrumentation and Fusion for Adult Degenerative Scoliosis
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DOI：
10.1111/os.12343
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发表时间：
2017-08-01
影响因子：
2.1
通讯作者：
Wang, Zheng
中科院分区：
文献类型：
--
作者：
Zhang, Hao-cong;Zhang, Zi-fang;Wang, Zheng
目的：评估脊柱侧凸研究协会（SRS）-Schwab骨盆发病率减去腰椎前凸不匹配（PI-LL）的矢状面修正值对成人退行性脊柱侧凸（ADS）长期后路内固定和融合后临床结局的影响。从2012年到2014年，对44例接受后路内固定和融合治疗的ADS患者进行了审查。通过站立整个脊柱（后前位和侧位视图）进行放射学评估。X线和所有放射学测量，包括Cobb角、LL、PI和椎骨旋转分级，均由两名对手术一无所知的经验丰富的外科医生进行。根据术后PI-LL和SRSSchwab分类将患者分为3组：0级PI-LL（20度，n = 12）。根据日本骨科协会（乔亚）评分、奥斯韦斯特里功能障碍指数（ODI）、视觉模拟量表（VAS）、腰椎僵硬功能障碍指数（LSDI）和并发症评估临床结局。还收集了患者的其他特征数据，包括术中失血量、手术时间、住院时间、并发症、融合节段数量和去骨关节次数。结果：平均手术时间、失血量和住院时间分别为284.5 ± 30.2 min、1040.5 ± 1207.6 mL和14.5 ± 1.9 d。末次随访（2.6 ± 0.6年）时，除椎体旋转分级外，其他影像学和功能参数均较术前显著改善（P < 0.05），但理想的PI-LL（0.05）明显改善。Pearson相关分析进一步证明LSDI与PI-LL呈负相关。PI-LL+级患者术后并发症发生率较低（1/19，5.26%）高于0（2/13，15.4%）和++级PI-LL（3/12，25%）。我们目前的研究表明，ADS患者在长时间后路内固定和融合后，理想的PI-LL可能在10 °和20 °之间。
Objective: To evaluate the influence of Scoliosis Research Society (SRS)-Schwab sagittal modifiers of pelvic incidence minus lumbar lordosis mismatch (PI-LL) on clinical outcomes for adult degenerative scoliosis (ADS) after long posterior instrumentation and fusion.Methods: This was a single-institute, retrospective study. From 2012 to 2014, 44 patients with ADS who underwent posterior instrumentation and fusion treatment were reviewed. Radiological evaluations were investigated by standing whole spine (posteroanterior and lateral views) X-ray and all radiological measurements, including Cobb's angle, LL, PI, and the grading of vertebral rotation, were performed by two experienced surgeons who were blind to the operations. The patients were divided into three groups based on postoperative PI-LL and the classification of the SRSSchwab: 0 grade PI-LL (20 degrees, n = 12). The clinical outcomes were assessed according to Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), Visual Analog Scale (VAS), Lumbar Stiffness Disability Index (LSDI), and complications. Other characteristic data of patients were also collected, including intraoperative blood loss, operative time, length of hospital stay, complications, number of fusion levels, and number of decompressions.Results: The mean operative time, blood loss, and hospital stay were 284.5 +/- 30.2 min, 1040.5 +/- 1207.6 mL, and 14.5 +/- 1.9 day. At the last follow-up (2.6 +/- 0.6 years), the radiological and functional parameters, except the grading of vertebral rotation, were all significantly improved in comparison with preoperative results (P < 0.05), but it was obvious that an ideal PI-LL ( 0.05). A Pearson correlation analysis further demonstrated that LSDI was negatively associated with PI-LL. Furthermore, the incidence rate of postoperative complications was lower in patients with + grade PI-LL (1/19, 5.26%) than that in patients with 0 (2/13, 15.4%) and ++ grade PI-LL (3/12, 25%).Conclusion: Our present study suggest that the ideal PI-LL may be between 10 degrees and 20 degrees in ADS patients after long posterior instrumentation and fusion.