脊柱-骨盆矢状位参数与腰椎退行性疾病术后持续性下腰痛的关系被引量：2

The Relationship Between Spinal-Pelvic Sagittal Parameters and Persistent Low Back Pain After Degenerative Lumbar Disease Surgery

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摘要目的分析脊柱-骨盆矢状位序列参数变化与腰椎退行性疾病(degenerative lumbar disease,DLD)患者术后持续性下腰痛的关系。方法选取天津市人民医院2019年6月至2022年6月行单节段腰椎融合内固定术治疗的86例DLD患者,根据术后是否发生持续性下腰痛分为腰痛组和非腰痛组。腰痛组34例,男10例,女24例;年龄32~77岁,平均(59.36±8.65)岁。非腰痛组52例,男21例,女31例;年龄30~78岁,平均(56.81±8.03)岁。比较两组患者一般资料、手术前后疼痛视觉模拟评分(visual analogue score,VAS)、日本骨科协会(Japanese orthopaedic association,JOA)腰椎功能评分及脊柱-骨盆矢状位序列参数[腰椎前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)]。分析术后持续性下腰痛发生的影响因素,分析手术前后脊柱-骨盆矢状位序列参数变化值与VAS、JOA评分变化值的相关性,分析手术前后脊柱-骨盆矢状位序列参数变化值及相关影响因素预测术后发生持续性下腰痛的价值。结果腰痛组骨质疏松、术中骨性终板损伤发生率(47.06%、23.53%)高于非腰痛组(15.38%、1.92%);腰痛组术后3个月VAS、PT高于非腰痛组,JOA评分、LL、SS低于非腰痛组,ΔVAS、ΔJOA、ΔLL、ΔPI、ΔPT、ΔSS小于非腰痛组(P<0.05);DLD患者ΔLL、ΔPT、ΔSS均与ΔVAS、ΔJOA间存在正相关关系(P<0.05),ΔPI与ΔVAS、ΔJOA间无明显相关性(P>0.05);骨质疏松、术中骨性终板损伤、ΔLL、ΔPT、ΔSS均为DLD患者术后发生持续性下腰痛的影响因素(P<0.05);ΔLL、ΔPT、ΔSS预测DLD患者术后发生持续性下腰痛的曲线下面积(area under the curve,AUC)分别为0.776、0.825、0.731;与ΔLL、ΔPT、ΔSS单独预测比较,ΔLL、ΔPT、ΔSS联合预测的AUC(0.939)明显增大,净重新分类指数、综合判别改善指数均>0(P<0.05)。结论脊柱-骨盆矢状位序列参数变化与DLD患者腰椎术后持续性下腰痛的发生有关,且在预测术后发生持续性下腰痛方面具有良好应用价值。 Objective To analyze the relationship between spinal and pelvic sagittal sequence parameters and persistent low back pain in patients with degenerative lumbar disease(DLD) after lumbar surgery.Methods Based on whether persistent low back pain occurred after surgery,86 patients with DLD who underwent single-level lumbar fusion and internal fixation in Tianjin People's Hospital from June 2019 to June 2022 were divided into a low back pain group and a non-low back pain group.The low back pain group included 34 patients,including 10 males and 24 females,with an average age of(59.36±8.65) years ranging from 32 to 77 years old.The non-low back pain group included 52 patients,including 21 males and 31 females,with an average age of(56.81±8.03) years ranging from 30 to 78 years old.By comparing the general data before surgery,the pain levels before and after surgery[visual analogue score(VAS)],lumbar function[Japanese orthopaedic association(JOA) score],and spine-pelvis sagittal sequence parameters[lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS)] between the two groups,we analyzed the influencing factors of persistent low back pain after surgery,and analyzed the correlation between the changes in spine-pelvis sagittal sequence parameters and VAS,JOA scores before and after surgery,and the value of predicting persistent low back pain after surgery by analyzing the changes in spine-pelvis sagittal sequence parameters and related influencing factors before and after surgery.Results The incidence of osteoporosis and intraoperative bone endplate injury in lumbago group(47.06%,23.53%)was higher than that in non-lumbago group(15.38%,1.92%).At 3months after operation,VAS score and PT in low back pain group were higher than those in non-low back pain group,JOA score,LL and SS were lower than those in non-low back pain group,andΔVAS,ΔJOA,ΔLL,ΔPI,ΔPT andΔSS were lower than those in non-low back pain group(all P<0.05).In DLD patients,ΔLL,ΔPT,ΔSS were positively correlated withΔVAS andΔJOA(P<0.05),whileΔPI was not significantly correlated withΔVAS andΔJOA(P>0.05).Osteoporosis,intraoperative bone endplate injury,ΔLL,ΔPT,ΔSS were the influencing factors of postoperative persistent low back pain in DLD patients(P <0.05).The area under the curve(AUC)ofΔLL,ΔPT andΔSS for predicting postoperative persistent low back pain in DLD patients were 0.776,0.825and 0.731,respectively.Compared with the single prediction ofΔLL,ΔPT andΔSS,the AUC(0.939)ofΔLL,ΔPT andΔSS combined prediction was significantly increased,and the net reclassification improvement(NRI)and inte-grated discrimination improvement(IDI)were both>0(P<0.05).Conclusion The variation of spinal and pelvic sagittal position sequence parameters is associated with the occurrence of persistent low back pain after lumbar surgery in DLD patients,and has good application value in predicting the occurrence of persistent low back pain after lumbar surgery.

作者袁建军李广张权任志帅刘岩田融 Yuan Jianjun;Li Guang;Zhang Quan;Ren Zhishuai;Liu Yan;Tian Rong(Spine and Spinal Cord Disease Diagnosis and Treatment Center,Tianjin People’s Hospital,Tianjin 300121,China)

机构地区天津市人民医院脊柱脊髓病诊疗中心

出处《实用骨科杂志》 2024年第2期115-119,152,共6页 Journal of Practical Orthopaedics

基金天津市卫生健康委员会科技项目(ZC20108) 天津市医学重点学科(专科)建设项目(TJYXZDXK-064B)。

关键词腰椎退行性疾病持续性下腰痛脊柱-骨盆矢状位序列参数相关性分析预测 lumbar degenerative diseases persistent low back pain spinal and pelvic sagittal sequence parameters correlation analysis forecast

分类号 R681.55 [医药卫生—骨科学]

作者简介袁建军(1973-),男,副主任医师,天津市人民医院脊柱脊髓病诊疗中心,Dr.yuanjianjun@163.com.