术前考虑矢状面平衡参数时,手术治疗中低度腰椎滑脱的功能结局:一项前瞻性研究。

Q2 Medicine
Sameh Elmorsy Hassan Elmorsy, Hazem Abdelsattar Abulnasr, Yousry Hassan, Magdy Samra, Ehab Mohamed Eissa
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引用次数: 0

摘要

背景:前瞻性研究目的。矢状面平衡是改善脊柱滑脱手术功能结果的一个很好的工具,首先注意到它在畸形手术中有很好的影响,然后应用于每一种脊柱手术,本研究的目的是在非发育不良的中低度脊柱滑脱手术的术前规划中考虑其功能结果。方法:40例诊断为中低度非发育不良性椎体滑脱的患者在开罗大学接受了手术治疗,术前通过测量矢状面平衡参数(包括SVA、脊柱-骨盆角、腰椎前凸、骨盆倾斜、骶骨斜度)进行了评估。和盆腔发生率,然后从2018年2月开始随访1年,并使用Oswestry评分(ODI)和VAS将其与功能结局相关联。术前通过人工估计和应用Surgimap对参数的校正进行估计,然后在手术期间应用。结果:所有患者均行常规螺钉或复位螺钉后经椎弓根螺钉内固定+融合+ TLIF笼手术治疗。腰椎前凸的平均值和脊柱骨盆角的平均值均有统计学意义的增加。骨盆倾斜降低,但统计学上不显著。盆腔发病率的平均值没有变化,统计学上不显著,这与盆腔发病率是一个恒定参数的事实相匹配。骶骨斜率增加,但无统计学意义。最终结果显示,37例患者的ODI在最后一次就诊时有统计学意义上的显著改善>20%。3例患者ODI评分较差,最终结果显示,37例患者在最后一次就诊时ODI改善>20%,具有统计学意义。3例患者临床预后较差,ODI评分改善>20%,我们注意到病理水平在L4L5水平,SVA阳性且术后加重,同时伴有腰椎前凸减小。在术前和术中考虑矢状面参数时,ODI的改变意味着统计学上显著的改善。结论:在低程度滑脱的手术治疗中应考虑矢状位平衡参数,以改善其功能预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively: a prospective study.

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively: a prospective study.

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively: a prospective study.

Functional outcome of surgical management of low mid-grade lumbar spondylolisthesis when considering the sagittal balance parameters preoperatively: a prospective study.

Background: Prospective study objectives. A sagittal balance is a good tool to improve the functional outcome of spine spondylolisthesis surgeries, primarily noted that it has a good impact in deformity surgery and then applied to every spine surgery and the aim of this study is to evaluate its functional outcome when considered in preoperative planning for non-dysplastic low- and mid-grade spondylolisthesis surgeries.

Method: Forty patients diagnosed as low- or mid-grade non-dysplastic spondylolisthesis had undergone surgery at Cairo University after failed medical treatment had been evaluated preoperatively by measuring the sagittal balance parameters which include SVA, spinopelvic angles, lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence and then measure it along a follow-up period of 1 year postoperatively started from February 2018 and correlate it with functional outcome using Oswestry score (ODI)and VAS. Correction of parameters has been estimated preoperatively by manual estimation and Surgimap application then applied during the operation.

Results: All patients were treated by surgical treatment through posterior transpedicular screw fixation with conventional or reduction screws and fusion ± TLIF cages. The mean of lumbar lordosis and mean spinopelvic angles were increased in a statistically significant manner. Pelvis tilt was decreased in a statistically insignificant manner. The mean of pelvic incidence was not changed and statistically insignificant, and this is matching the fact that pelvic incidence is a constant parameter. The sacral slope was increased in a statistically insignificant manner. Final results showed that 37 had a statistically significant improvement in their ODI >20% at the last visit. Three patients had a poor clinical outcome with ODI scorFinal results showed that 37 had a statistically significant improvement in their ODI >20% at the last visit. Three patients had a poor clinical outcome with ODI score of >20% improvement, and we noticed that the level of pathology was at the level of L4L5, SVA was positive and worsen postoperatively, and also, it is accompanied by decreased lumbar lordosis. Change in ODI means statistically significant improvement when considering sagittal parameters preoperation and during operation.

Conclusion: Sagittal balance parameters should be considered in the surgical management of low-grade spondylolisthesis cases to improve their functional outcome.

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