关键词: 退变性腰椎管狭窄症,  , 腰骶椎体间融合,  , 多节段,  , 脊柱骨盆参数,  , 临床疗效

Abstract:

Objective To investigate the changes of spinal and pelvic parameters after multi⁃level lumbo⁃ sacral fusion in patients with degenerative lumbar spinal stenosis. Methods From June 2018 to June 2020，a total of 85 patients with multil ⁃level degenerative lumbar spinal stenosis underwent lumbosacral interbody fusion，and were followed for（24 ± 2.18）months，divided into balanced groups based on preoperative and last follow⁃up SVA （sagittal vertical axis，SVA）50 mm. SVA > 50 mm was classified as unbalanced group. Preoperative and last follow⁃up spino⁃pelvic parameters were measured，and the OSWESTRY disability index（ODI）and SF⁃36（the MOS item short from health survey，SF⁃36）scores were performed. The overall curative effect was evaluated according to the modified MacNab criteria at the last follow⁃up，and the changes of spinal and pelvic parameters and the clinical curative effect were statistically analyzed. Results In the preoperative group，the SVA of the unbalanced group was significantly improved before and after operation（P < 0.01），while there was no significant difference in the preoperative and postoperative changes of the balanced group. The ODI and SF⁃36 scores of both groups were improved after operation compared with those before operation（P < 0.01），and there was no significant difference between the two groups. In the postoperative group，there were statistically significant differences in ODI and SF⁃36 scores between the two groups（P < 0.01），and the balance group was better than the unbalanced group. There were statistical differences in △LL and △HOD/n（height of disc，HOD）of the lumbar department between the two groups（P < 0.01）. In 85 cases，△LL was positively correlated with △HOD/n（r = 0.73）. According to the modified MacNab standard，50 cases were excellent，22 cases were good，7 cases were fair，6 cases were poor， with an excellent and good rate was 84.7%（72/85）. Conclusion Decompression and fusion surgery is effective for multi⁃level degenerative lumbar spinal stenosis. Patients′ postoperative outcomes can be improved by restoring theheight of the intervertebral disc to increase LL and improve sagittal balance.

Key words:

lumbosacral diseases of the lumbar spine, lumbosacral interbody fusion, multiple segment, spinal and pelvic parameters, health?related quality of life