椎体间融合内固定治疗腰椎滑脱症：脊柱-骨盆参数的变化

背景：脊柱-骨盆参数的异常与腰椎椎体滑脱症的发生、进展密切相关。 目的：探讨腰椎椎体滑脱症患者内固定治疗后脊柱-骨盆参数的变化及临床意义。 方法：行腰椎椎体滑脱症后路腰椎椎体间融合内固定治疗且有完整随访资料的患者共60例，测量分析所有患者内固定前后X射线平片的腰椎前凸、骨盆投射角、骶骨倾斜角和骨盆倾斜角、矢状面平衡、椎体滑脱度、椎体滑脱角和椎间盘高度。将上述参数植入前后测量结果进行配对t检验比较，并对相关参数指标进行相关分析。 结果与结论：植入前后滑脱度、滑脱角、椎间盘高度、腰椎前凸、骨盆倾斜角、骶骨倾斜角及矢状面平衡比较，差异均有显著性意义(P < 0.01)。椎间盘高度的恢复与腰椎前凸、骨盆倾斜角、骶骨倾斜角、滑脱度及滑脱角的变化存在明显的线性相关，腰椎前凸的变化与滑脱角、滑脱度、骨盆倾斜角及骶骨倾斜角的变化存在线性相关。说明后路腰椎椎间融合内固定能够显著地改善腰椎椎体滑脱症患者的骶骨倾斜角、骨盆倾斜角、腰椎前凸及矢状面平衡；运用后路腰椎椎间融合内固定治疗腰椎椎体滑脱症患者，必须考虑不同骨盆投射角下的骨盆代偿模式，个体化地重建椎间盘高度。

Interbody fusion and internal fixation for lumbar spondylolisthesis: Changes of spnio-pelvic parameters

BACKGROUND:Abnormality of spnio-pelvic parameters is closely related to the occurrence and progress of lumbar spondylolisthesis. OBJECTIVE:To explore the change and clinical significance of spino-pelvic parameters in lumbar spondylolisthesis patients after internal fixation. METHODS:A retrospective analysis was conducted on 60 patients with lumbar spondylolisthesis undergoing posterior lumbar interbody fusion and internal fixation. The pre-and post-operative lumbarlordosis, pelvic projectional angle, sacralslope angle, pelvic tilting angle, sagittal balance, slip degree, slip angle and height of intervertebral disc were measured on X-ray film. These parameters were analyzed using t-test between pre- and post-operation. Linear correlations between these parameters were analyzed. RESULTS AND CONCLUSION:There were significant differences between pre- and post-operative slip degree, slip angle, height of intervertebral disc, lumbar lordosis, pelvic tilting, sacral slope and sagittal balance (P < 0.01). The restoration of height of intervertebral disc showed significant correlation with the change of lumbar lordosis, pelvic tilting, sacral slope, slip degree and slip angle. The change of lumbar lordosis was significantly correlated with the change of slip angle, slip degree, pelvic tilting and sacral slope. It indicates that posterior lumbar interbody fusion and internal fixation can significantly improve the sacral slope, pelvic tilting, lumbar lordosis and sagittal balance of the patients with lumbar spondylolisthesis. Therefore, when treating lumbar spondylolisthesis patients with posterior lumbar interbody fusion and internal fixation, compensatory mode of pelvis with different pelvic projectional angles must be considered, and surgical surgeons should restore the height of intervertebral disc individually.