目的:骨盆发生率减去腰椎前凸不匹配(PI-LL)与成人退行性脊柱侧凸(ADS)患者的生活质量差直接相关。该研究的目的是确定ADS患者的最合适的术后PI-LL值。
方法:回顾性收集我科ADS患者的病历资料。数据包括年龄,性别,身体质量指数,年龄调整后的Charlson合并症指数,骨质减少,住院时间,手术持续时间,估计失血量,美国麻醉医师协会评分,融合水平的数量,腰椎前凸,矢状垂直轴,骨盆发病率,PI-LL,SRS-22得分,ODI得分,机械并发症。
结果:共纳入316例患者。PI-LL,腰椎前凸,矢状垂直轴,SRS-22得分,末次随访时ODI评分为20.7±8.5°,23.4±14.1°,4.0±2.1cm,分别为3.7±0.9和18.1±5.5。就机械并发症而言,88例患者(27.8%),34例(10.8%),19例(6.0%)有近端交界性脊柱后凸,远端交界后凸畸形,和植入物相关的并发症,分别。在完全调整的模型中,与0级PI-LL组和++级PI-LL组相比,PI-LL+分级组临床结局最好,机械性并发症最少。在敏感性分析中验证了这些结论的稳定性。
结论:成人退变性脊柱侧凸患者矫正手术后最佳PI-LL值为10°-20°,这与优异的临床结果和较低的并发症发生率相关。以前的标准可能有过度修正的风险,这可能导致近端交界性脊柱后凸。
OBJECTIVE: Pelvic incidence minus lumbar lordosis mismatch (PI-LL) is directly related to poor quality of life in adult degenerative scoliosis (ADS) patients. The purpose of the study was to determine the most appropriate postoperative PI-LL value for patients with ADS.
METHODS: The medical records of patients with ADS in our department were retrospectively collected. The data included age, sex, body mass index, age-adjusted Charlson comorbidity index, osteopenia, length of hospital stay, operative duration, estimated blood loss, American Society of Anaesthesiologists score, number of fusion levels, lumbar lordosis, sagittal vertical axis, pelvic incidence, PI-LL, SRS-22 score, ODI score, and mechanical complications.
RESULTS: A total of 316 patients were enrolled. PI-LL, lumbar lordosis, sagittal vertical axis, SRS-22 score, ODI score at the time of last follow-up were 20.7±8.5°, 23.4±14.1°, 4.0±2.1 cm, 3.7±0.9, and 18.1±5.5, respectively. In terms of mechanical complications, 88 patients (27.8%), 34 patients (10.8%), and 19 patients (6.0%) had proximal junctional kyphosis, distal junctional kyphosis, and implant-related complications, respectively. In the fully adjusted model, compared with 0 grade PI-LL group and ++ grade PI-LL group, + grade PI-LL group had the best clinical outcomes and the fewest mechanical complications. The stability of these conclusions was verified in sensitivity analyses.
CONCLUSIONS: Optimal PI-LL value should be 10°-20° after corrective surgery in patients with adult degenerative scoliosis, which is associated with excellent clinical outcomes and lower complication rates. Previous criteria may be at risk of overcorrection, which may lead to proximal junctional kyphosis.