| 胡丽丹,周鹃,鄂梦迪,等.腰椎融合术后慢性腰痛与脊柱-骨盆矢状位参数的相关性研究.骨科,2026,17(2): 117-122. |
| 腰椎融合术后慢性腰痛与脊柱-骨盆矢状位参数的相关性研究 |
| Correlation between chronic low back pain after lumbar fusion and spinal-pelvic sagittal parameters |
| 投稿时间：2025-05-12 |
| DOI：10.3969/j.issn.1674-8573.2026.02.004 |
| CN KeyWords: 腰椎融合术 慢性腰痛 脊柱-骨盆矢状位 相关性 |
| EN KeyWords: Lumbar fusion surgery Chronic low back pain Spine-pelvic sagittal Correlation |
| Fund Project:湖北省自然科学基金项目（2023AFD141） |
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| CN Abstract: |
| 目的 分析腰椎融合术后慢性腰痛（chronic low back pain，CLBP）与脊柱-骨盆矢状位参数的相关性。方法 回顾性分析2023年1月至2024年6月我科收治的79例经腰椎融合术治疗的患者，根据术后是否出现慢性腰痛分为腰痛组（CLBP组）和非腰痛组（非CLBP组），其中CLBP组25例，男10例，女15例，年龄（58.52±7.02）岁（47~71岁）；非CLBP组54例，男22例，女32例，年龄（60.04±7.21）岁（43~73）岁。比较两组患者多裂肌脂肪浸润分级、术后邻近节段退变（ASD）情况、脊柱-骨盆矢状位参数，以及手术前后疼痛视觉模拟量表（VAS）评分和日本骨科协会（JOA）评分的绝对变化值（△VAS和△JOA），并分析各指标与△VAS、△JOA的相关性。结果 两组患者术前多裂肌脂肪浸润分级及术后ASD发生情况比较，差异无统计学差异（P＞0.05）。末次随访时，CLBP组的骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）、腰椎前凸角（LL）与术前相比，差异无统计学意义（P＞0.05），而非CLBP组PT、SS、LL与术前相比，差异有统计学意义（P＜0.05）。与CLBP组相比，非CLBP组在PT、SS、LL方面的改善更为明显，术后腰椎骨盆匹配值（|PI-LL|）更低，差异有统计学意义（P＜0.05），但两组患者术后PI、腰椎前凸指数（LLI）比较，差异无统计学意义（P＞0.05）。采用Pearson相关系数法分析，△VAS与△PT、△SS、腰椎前凸角变化值（LLC）呈正相关（r=0.568、0.544、0.442，P＜0.05），△JOA亦与△PT、△SS、LLC呈正相关（r=0.585、0.589、0.410，P＜0.05），两者与PI、|PI-LL|均无相关性（P＞0.05）。结论 脊柱-骨盆矢状位序列参数变化可能是腰椎融合术后慢性腰痛原因，术中需重建脊柱-骨盆矢状位平衡，降低PT，重建LL，可以有效减少术后慢性腰痛的发生。 |
| EN Abstract: |
| Objective To investigate the correlation between spine-pelvic sagittal parameters and chronic low back pain (CLBP) following lumbar fusion surgery. Methods A cohort of 79 patients undergoing lumbar fusion surgery at our department between January 2023 and June 2024 was retrospectively analyzed. The participants were stratified into the CLBP group and the non-CLBP group based on whether CLBP occurred after surgery. The CLBP group consisted of 25 cases, including 10 males and 15 females, aged (58.52±7.02) years (47-71 years), while the non-CLBP group included 54 cases, comprising 22 males and 32 females, with the age of (60.04±7.21) years (43-73 years). The grades of multifidus muscle fat infiltration, postoperative adjacent segment degeneration (ASD), spine-pelvic sagittal parameters, and the absolute value of change of Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) scores (△VAS and △JOA) were compared between two groups, and correlations between △VAS, △JOA and parameter alterations were analyzed. Results There was no statistically significant difference between the two groups in the preoperative classification degree of multifidus muscle fat infiltration and the occurrence of ASD. At the final follow-up, postoperative pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) in the CLBP group showed no significant changes from preoperative values (P＞0.05), whereas the non-CLBP group displayed marked improvements in PT, SS and LL (P＜0.05). The non-CLBP group exhibited significantly greater enhancements in PT, SS, LL than the CLBP group (P＜0.05), while a statistically significant difference was also found in the postoperative pelvic-lumbar matching values (|PI-LL|) between the two groups (P＜0.05), but no significant differences were observed in postoperative PI or the lumbar lordosis index (LLI) (P＞0.05). Pearson correlation analysis revealed that △VAS was positively correlated with PT, SS, and LLI variations (r=0.568, 0.544, 0.442; P＜0.05), while △JOA was correlated with PT, SS, and LLI variations (r=0.585, 0.589, 0.410; P＜0.05). Neither score was correlated with PI or |PI-LL| (P＞0.05). Conclusion Alterations in spine-pelvic sagittal parameters may contribute to postoperative CLBP. Intraoperative reconstruction of spine-pelvic sagittal balance, specifically reducing PT and restoring physiological LL, could mitigate the incidence of chronic pain. |
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