【摘要】：背景近年來(lái),脊柱骨盆影像學(xué)參數(shù)在脊柱疾病診療中的作用越來(lái)越受到重視;脊柱骨盆影像學(xué)參數(shù)不但在脊柱畸形的診治中具有重要意義,并且也逐漸認(rèn)識(shí)到在頸椎病、腰椎間盤突出癥、腰椎滑脫癥、胸腰椎壓縮性骨折等疾病的診治中同樣具有重要意義。脊柱骨盆影像學(xué)參數(shù)可分為整體參數(shù)與局部參數(shù)。大量研究認(rèn)為臨床癥狀、生活質(zhì)量與整體脊柱冠狀面參數(shù)失常無(wú)明顯相關(guān)性,而與整體矢狀面參數(shù)失常密切相關(guān)。如研究表明整體矢狀面平衡是改善成人脊柱畸形臨床療效最重要的因素。和整體脊柱參數(shù)一樣,局部脊柱參數(shù)也是影響手術(shù)并發(fā)癥及生活質(zhì)量的重要因素。如腰椎前凸角是影響成人脊柱畸形術(shù)后疼痛及患者生活質(zhì)量重要的局部影像學(xué)參數(shù)。脊柱骨盆參數(shù)失�？蓪�(dǎo)致脊柱畸形、疼痛、功能障礙和手術(shù)并發(fā)癥等,均嚴(yán)重影響患者生活質(zhì)量;而脊柱骨盆參數(shù)的恢復(fù)與良好的治療效果密切相關(guān)。脊柱外科醫(yī)生將脊柱骨盆影像學(xué)參數(shù)與患者癥狀、手術(shù)并發(fā)癥和生活質(zhì)量聯(lián)系起來(lái)的能力將對(duì)脊柱疾病手術(shù)決策和手術(shù)規(guī)劃非常有益。目前,雖然對(duì)脊柱骨盆參數(shù)在脊柱疾病中的作用有了部分的了解,但是脊柱骨盆參數(shù)在脊柱疾病中的作用尚處于初步發(fā)展階段,仍存在許多理論上的盲區(qū),如哪些參數(shù)影響了手術(shù)并發(fā)癥、哪些參數(shù)的變化對(duì)患者生活質(zhì)量的改善最有預(yù)測(cè)意義等問(wèn)題,均需要進(jìn)一步的研究。所以,本論文擬對(duì)局部脊柱骨盆參數(shù)和整體脊柱骨盆參數(shù)在脊柱疾病手術(shù)并發(fā)癥和生活質(zhì)量改善兩方面進(jìn)行研究。脊髓型頸椎病(CSM)是老年人群中最常見(jiàn)的脊柱神經(jīng)系統(tǒng)疾病之一。1977年Hirabayashi等設(shè)計(jì)的傳統(tǒng)頸椎單開(kāi)門椎管擴(kuò)大成形術(shù)(CL)已被廣泛用于治療CSM。CL技術(shù)簡(jiǎn)單,也帶來(lái)了滿意的臨床結(jié)果,但是它也產(chǎn)生了多種并發(fā)癥,如術(shù)后軸性癥狀(post-AS),椎板再關(guān)門,頸椎活動(dòng)度丟失和C5神經(jīng)根麻痹等。因此很多改良的術(shù)式被發(fā)明應(yīng)用以減少這些并發(fā)癥。微型鈦板固定技術(shù)是一種改良術(shù)式(ML)。然而post-AS仍然是此改良術(shù)式一個(gè)常見(jiàn)的嚴(yán)重并發(fā)癥。頸椎椎管擴(kuò)大成形手術(shù)的post-AS總發(fā)生率為29%到73. 3%。雖然post-AS不致命,但post-AS往往嚴(yán)重到足以擾亂患者正常的日常生活,并成為術(shù)后主要并發(fā)癥。Post-AS的病因尚不清楚。重要的是要知道哪些術(shù)前頸椎影像學(xué)參數(shù)和臨床參數(shù)是術(shù)后軸性癥狀的預(yù)測(cè)影響因素。一些研究試圖描述post-AS和危險(xiǎn)因素之間的關(guān)系。然而,這些研究?jī)H是間接的和回顧性的,或只使用單因素分析。一個(gè)只包括改良術(shù)式組的回顧性研究結(jié)果表明,頸椎活動(dòng)范圍、小關(guān)節(jié)的破壞等因素可能與post-AS有關(guān)。上述回顧性研究的主要不足是缺乏一個(gè)對(duì)照組,因此它不能確定哪種手術(shù)方法在減少術(shù)后軸性癥狀方面更有優(yōu)勢(shì)。因此需要一個(gè)前瞻性的、對(duì)比的、多因素回歸分析來(lái)確定影響post-AS最有預(yù)測(cè)力的術(shù)前因素,主要是術(shù)前頸椎影像學(xué)參數(shù)。成人退變性脊柱側(cè)凸(ADS)主要癥狀有腰痛、腿痛和脊柱畸形,并且這種畸形多伴有矢狀面和冠狀面失平衡。ADS作為成人脊柱側(cè)凸中最常見(jiàn)的類型,是最具挑戰(zhàn)性的復(fù)雜脊柱畸形之一。對(duì)ADS進(jìn)行手術(shù)干預(yù)是技術(shù)上的巨大挑戰(zhàn),并可帶來(lái)嚴(yán)重并發(fā)癥和不良后果,像疼痛加重、神經(jīng)損傷、功能降低、交界性后凸等,這些并發(fā)癥都擾亂患者正常的日常生活,嚴(yán)重影響患者生活質(zhì)量�，F(xiàn)在,逐步認(rèn)識(shí)到成人脊柱畸形的治療效果評(píng)價(jià)不但包括影像學(xué)參數(shù)評(píng)價(jià),更重要的是對(duì)患者生活質(zhì)量的評(píng)價(jià)。在成人脊柱側(cè)凸中,一些研究已經(jīng)顯示了部分脊柱骨盆參數(shù)與臨床癥狀的關(guān)系,但是這些研究只是關(guān)注了術(shù)前脊柱骨盆參數(shù)與術(shù)前臨床癥狀的關(guān)系,或只是關(guān)注了術(shù)后脊柱骨盆參數(shù)與術(shù)后臨床癥狀的關(guān)系。另外,ADS需要區(qū)別于成人脊柱側(cè)凸其他類型,因?yàn)锳DS是由于脊柱結(jié)構(gòu)性元素進(jìn)行性退變導(dǎo)致的脊柱畸形,而成人脊柱側(cè)凸是一個(gè)集體名詞,包括所有骨骼發(fā)育成熟后的脊柱畸形類型。據(jù)我們所知,目前文獻(xiàn)缺少只包括成人退變性脊柱側(cè)凸患者的脊柱骨盆參數(shù)的即刻變化和生活質(zhì)量改善相關(guān)性的研究。而在面對(duì)此類病人時(shí),這個(gè)相關(guān)性對(duì)脊柱外科醫(yī)生計(jì)劃手術(shù)方案和推測(cè)預(yù)后是非常有用的。因此,本研究的目的是探討脊柱骨盆參數(shù)在頸椎病術(shù)后軸性癥狀與退變性側(cè)凸患者生活質(zhì)量改善中的作用。本研究共分兩個(gè)部分,第一部分是研究局部脊柱骨盆影像學(xué)參數(shù)—頸椎參數(shù):術(shù)前頸椎影像學(xué)參數(shù)在影響脊髓型頸椎病術(shù)后軸性癥狀中的作用;第二部分是研究整體和局部脊柱骨盆影像學(xué)參數(shù):脊柱骨盆參數(shù)的術(shù)后即刻變化與成人退變性脊柱側(cè)凸患者生活質(zhì)量改善的相關(guān)性。第一部分術(shù)前頸椎影像學(xué)參數(shù)在脊髓型頸椎病單開(kāi)門術(shù)后軸性癥狀中的作用目的采用多因素邏輯回歸分析研究影響術(shù)前軸性癥狀的術(shù)前頸椎參數(shù)和臨床參數(shù);通過(guò)前瞻性的對(duì)比不同術(shù)式和多因素回歸分析來(lái)闡明影響(危險(xiǎn)或保護(hù))post-AS的術(shù)前頸椎參數(shù)和臨床參數(shù)。材料與方法選擇山東省聊城市人民醫(yī)院脊柱外科自2009年3月至2015年9月行頸椎后路單開(kāi)門椎管擴(kuò)大成形術(shù)的脊髓型頸椎病患者。根據(jù)手術(shù)日期,患者被前瞻性的分配至不同的手術(shù)方式組。從2009年3月至2011年7月,病人是被安排行傳統(tǒng)手術(shù)(粗絲線固定,CL組)。從2011年9月至2015年9月,病人是被安排行改良手術(shù)(微型鈦板固定,ML組)。評(píng)價(jià)指標(biāo):①術(shù)前頸椎影像學(xué)參數(shù):頸椎前凸角(CCA),頸椎管前后徑(APD),頸椎矢狀面平衡(C2-7SVA),頸髓參數(shù)(HSI);②臨床指標(biāo):年齡、性別、手術(shù)方式(CL、ML)、手術(shù)時(shí)間、失血量、術(shù)前JOA評(píng)分及是否有術(shù)前軸性癥狀(pre-AS)。軸性癥狀(AS)評(píng)價(jià):根據(jù)Hosono等的標(biāo)準(zhǔn),把AS分為四級(jí),其中評(píng)價(jià)為良好或輕微的是被定義為無(wú)AS,評(píng)價(jià)為較重或嚴(yán)重的并癥狀持續(xù)1個(gè)月是被定義為有AS。Pre-AS及post-AS都被評(píng)價(jià)記錄。其中post-AS是在術(shù)后6-8個(gè)月時(shí)評(píng)價(jià)。SPSS 20.0統(tǒng)計(jì)軟件進(jìn)行數(shù)據(jù)分析:多因素邏輯回歸分析確定影響術(shù)前軸性癥狀的術(shù)前因素;兩種術(shù)式的術(shù)后軸性癥狀進(jìn)行前瞻性對(duì)比分析研究;最后用多因素邏輯回歸分析確定影響術(shù)后軸性癥狀的術(shù)前因素。統(tǒng)計(jì)檢驗(yàn)的顯著性均設(shè)定為P0.05。結(jié)果:1.納入患者例數(shù):共有102例患者被納入本研究,其中CL組:44例,ML組:58例。組間比較:在CL組和ML組之間,年齡、性別、手術(shù)時(shí)間、失血量、術(shù)前JOA評(píng)分、是否有pre-AS、CCA、APD、C2-7SVA、HSI無(wú)顯著差異。2.總的術(shù)前軸性癥狀的發(fā)生率為29.4% (30/102)。傳統(tǒng)術(shù)式組pre-AS的發(fā)生率為25.0% (11/44),改良術(shù)式組為32.8% (19/58)。兩組間pre-AS發(fā)生率無(wú)顯著差異(P=0.394)。多因素回歸分析表明術(shù)前CCA是影響pre-AS的頸椎影像學(xué)因素(P=0.011,oddsratio=0.930),其他術(shù)前因素都不是。進(jìn)一步分析表明,與未患有pre-AS的患者相比,患有pre-AS的患者具有更小的術(shù)前 CCA(P=0.004)。3.總的術(shù)后軸性癥狀的發(fā)生率為40.2% (41/102)。傳統(tǒng)術(shù)式組post-AS的發(fā)生率為54.5% (24/44),改良術(shù)式組為29.3% (17/58)。兩組間post-AS發(fā)生率有顯著差異(P=0.010)。多因素回歸分析表明ML和CCA是影響post-AS的術(shù)前因素(ML: P=0.011,odds ratio=0.302; CCA: P=0.042, odds ratio=0.947),其他因素都不是。進(jìn)一步分析表明,與未發(fā)生post-AS的病人相比,發(fā)生post-AS的病人具有更小的術(shù)前CCA(P=0.043)。結(jié)論:該部分研究表明更小的術(shù)前頸椎前凸角是術(shù)前軸性癥狀的危險(xiǎn)因素;通過(guò)選擇有更大術(shù)前頸椎前凸角的患者或應(yīng)用微型鈦板固定技術(shù)可以降低脊髓型頸椎病單開(kāi)門手術(shù)的術(shù)后軸性癥狀。第二部分脊柱骨盆參數(shù)的即刻變化與退變性側(cè)凸矯形患者生活質(zhì)量改善的相關(guān)性分析目的在成人退變性脊柱側(cè)凸患者中,對(duì)比分析手術(shù)前、后脊柱骨盆參數(shù)和生活質(zhì)量的差異;通過(guò)單變量和多變量線性回歸分析評(píng)估脊柱骨盆參數(shù)的即刻變化與患者生活質(zhì)量改善的相關(guān)性。材料與方法我們對(duì)收集了成人退變性脊柱側(cè)凸矯形手術(shù)的單中心數(shù)據(jù)庫(kù)進(jìn)行了回顧性研究。脊柱骨盆參數(shù)包括脊柱冠狀位參數(shù)、脊柱矢狀位參數(shù)和骨盆參數(shù)。脊柱冠狀位參數(shù)包含最大Cobb角、冠狀位平衡(CVA);脊柱骨盆矢狀面平衡包含矢狀面平衡(SVA)、腰椎前凸角(LL)、胸椎后凸角(TK)、骨盆傾斜角(PT)和骶骨傾斜角(SS)。生活質(zhì)量的評(píng)估采用兩個(gè)調(diào)查問(wèn)卷(ODI和VAS)對(duì)患者進(jìn)行功能障礙程度、疼痛的評(píng)分。脊柱骨盆參數(shù)的即刻變化(△)和生活質(zhì)量改善(△)是被分別定義的。用配對(duì)t檢驗(yàn)和線性回歸分析進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析。結(jié)果共52名患者符合標(biāo)準(zhǔn),包括13名男性和39名女性。隨訪時(shí)間平均為40個(gè)月(范圍,25-78個(gè)月)。手術(shù)時(shí)的平均年齡為56歲(范圍,50-67歲)。平均融合節(jié)段為8.4個(gè)椎體(范圍,5-11個(gè)椎體)�；颊咝g(shù)前和術(shù)后即刻的脊柱骨盆參數(shù),在Cobb角(P0.001)、SVA(P0.001)、LL (P0.001)、TK (P=0.025)、PT (P=0.009)和 SS (P=0.007)表現(xiàn)出顯著性差異,但CVA(P=0.937)未見(jiàn)顯著性差異。最后一次隨訪時(shí)ODI和VAS評(píng)分與術(shù)前相比有顯著性改善(二者均P0.001)。單因素回歸分析發(fā)現(xiàn),△ SVA(P=0.002)、△ LL (P=0.002)和 △ TK (P=0.009)與△ODI呈顯著相關(guān)性。多因素回歸分析發(fā)現(xiàn)只有△SVA(P=0.009)和△LL(P=0.016)仍和△ ODI呈顯著相關(guān)性,△ TK (P=0.581)被排除在外。也就是說(shuō),SVA每增加1mm, ODI預(yù)計(jì)增加0.347; LL每增加1°,ODI預(yù)計(jì)減少0.336。單因素回歸分析發(fā)現(xiàn),△SVA(P0.001)、△LL(P=0.017)和 △TK(P=0.032)與△ VAS呈顯著相關(guān)性。多因素回歸分析發(fā)現(xiàn)只有△SVA(P0.001)和△LL(P=0.046)仍和△ VAS呈顯著相關(guān)性,△ TK (P=0.926)被排除在外。也就是說(shuō),SVA每增加1mm, VAS預(yù)計(jì)增加0.520; LL每增加1°,VAS預(yù)計(jì)減少0.264。結(jié)論矯形手術(shù)顯著改善了成人退變性脊柱側(cè)凸患者的脊柱骨盆參數(shù)(除了 CVA)和生活質(zhì)量。對(duì)成人退變性脊柱側(cè)凸患者來(lái)說(shuō),減少SVA和增加LL是手術(shù)獲得較高生活質(zhì)量改善的關(guān)鍵目標(biāo)。TK的即刻改變是影響患者生活質(zhì)量改善的混雜因素,同時(shí)脊柱冠狀位參數(shù)和骨盆參數(shù)的即刻改變都不是患者生活質(zhì)量改善的顯著性預(yù)測(cè)因素。
[Abstract]:Background In recent years, more and more attention has been paid to the role of spinal and pelvic imaging parameters in the diagnosis and treatment of spinal diseases; spinal and pelvic imaging parameters are not only important in the diagnosis and treatment of spinal deformities, but also gradually recognized in the diagnosis and treatment of cervical spondylosis, lumbar disc herniation, lumbar spondylolisthesis, thoracolumbar compression fractures and other diseases. The imaging parameters of the spine and pelvis can be divided into global parameters and local parameters. Many studies have shown that clinical symptoms, quality of life and overall spinal coronal parameters are not significantly correlated, but with overall sagittal parameters are closely related. For example, studies have shown that overall sagittal balance is to improve the imminence of adult spinal deformity. As with the overall spinal parameters, local spinal parameters are also important factors affecting postoperative complications and quality of life. For example, lumbar lordosis angle is an important local imaging parameter affecting postoperative pain and quality of life in adult spinal deformities. Dysfunction and surgical complications severely affect the patient's quality of life, and the recovery of spinal and pelvic parameters is closely related to good treatment outcomes. At present, although the role of spine and pelvis parameters in spinal diseases has been partly understood, the role of spine and pelvis parameters in spinal diseases is still in the initial stage of development, there are still many theoretical blind spots, such as which parameters affect the surgical complications, which parameters change the most to improve the quality of life of patients. Therefore, this paper intends to study the local spine and pelvis parameters and the overall spine and pelvis parameters in the aspects of surgical complications and quality of life. Cervical spondylotic myelopathy (CSM) is one of the most common spinal and nervous system diseases in the elderly. Hirabayas, 1977 Hi and other traditional open-door cervical laminoplasty (CL) has been widely used in the treatment of CSM.CL with simple technique and satisfactory clinical results, but it also produces a variety of complications, such as post-AS, lamina reopening, loss of cervical mobility and C5 nerve root paralysis. Mini-titanium plate fixation is an improved procedure (ML). However, post-AS remains a common and serious complication of this modified procedure. The overall incidence of post-AS in cervical spinal canal dilatation surgery ranges from 29% to 73.3%. Although post-AS is not fatal, post-AS is often severe enough to disrupt the patient's normal day. The etiology of Post-AS remains unclear. It is important to know which preoperative cervical imaging parameters and clinical parameters are predictors of postoperative axial symptoms. Some studies attempt to describe the relationship between post-AS and risk factors. However, these studies are only indirect and retrospective, or A retrospective study involving only the modified procedure group showed that the range of motion of the cervical spine and the destruction of facet joints might be associated with post-AS. Therefore, a prospective, comparative, multivariate regression analysis is needed to determine the most predictive preoperative factors affecting post-AS, mainly preoperative cervical spine imaging parameters. The main symptoms of adult degenerative scoliosis (ADS) are low back pain, leg pain, and spinal deformities, which are often associated with sagittal and coronal imbalances. Adult scoliosis is one of the most common and challenging complex spinal deformities. Surgical intervention with ADS is a major technical challenge and can lead to serious complications and adverse consequences, such as increased pain, nerve injury, dysfunction, borderline kyphosis, and so on. These complications disrupt the normal daily life of patients. In adult scoliosis, some studies have shown the relationship between some spinal pelvic parameters and clinical symptoms, but these studies are only relevant. In addition, ADS needs to be distinguished from other types of adult scoliosis, because ADS is a spinal deformity caused by progressive degeneration of spinal structural elements, and adult scoliosis is a collection. Body terms, including all types of spinal deformities after bone maturation. As far as we know, there is a lack of literature on the correlation between immediate changes in spinal pelvic parameters and improved quality of life in adults with degenerative scoliosis. The purpose of this study was to investigate the role of spinal and pelvic parameters in improving the quality of life in patients with cervical spondylosis and degenerative scoliosis after surgery. The second part is to study the overall and local spinal and pelvic imaging parameters: the correlation between immediate changes of spinal and pelvic parameters and the improvement of quality of life in adult patients with degenerative scoliosis. Objective To analyze the preoperative cervical spine parameters and clinical parameters affecting preoperative axial symptoms by multivariate logistic regression analysis, and to clarify the preoperative cervical spine parameters and clinical parameters affecting (risk or protection) post-AS by prospective comparison of different surgical methods and multivariate regression analysis. Patients with cervical spondylotic myelopathy who underwent posterior open-door laminoplasty in the Department of Spinal Surgery of Liaocheng People's Hospital from March 2009 to September 2015 were prospectively assigned to different surgical groups according to the date of operation. From March 2009 to July 2011, patients were assigned to traditional surgery (coarse-wire fixation, CL group). From September 11 to September 2015, patients were scheduled to undergo modified surgery (mini-titanium plate fixation, ML group). Evaluation indicators: 1. Preoperative cervical imaging parameters: cervical lordosis angle (CCA), anterior and posterior diameter of cervical spinal canal (APD), cervical sagittal balance (C2-7SVA), cervical spinal cord parameters (HSI); 2. Clinical indicators: age, sex, operation mode (CL, ML), operation time, blood loss, and operation. Pre-JOA score and preoperative axial symptoms (pre-AS). Assessment of axial symptoms (AS): According to Hosono's criteria, AS was classified into four grades, in which good or mild AS was defined as absence, in which severe or severe symptoms lasting for one month were defined as AS. Pre-AS and post-AS. Post-AS was recorded during surgery. SPSS 20.0 statistical software for data analysis: multivariate logistic regression analysis to determine preoperative factors affecting preoperative axial symptoms; two types of postoperative axial symptoms for prospective comparative analysis; and finally multivariate logistic regression analysis to determine preoperative factors affecting postoperative axial symptoms. Results: 1. A total of 102 patients were enrolled in this study, including CL group: 44 cases, ML group: 58 cases. Intergroup comparison: between CL group and ML group, age, sex, operation time, blood loss, preoperative JOA score, whether pre-AS, CCA, APD, C2-7SVA, HSI had no significant difference. The incidence of pre-AS was 25.0% (11/44) in the traditional operation group and 32.8% (19/58) in the modified operation group. There was no significant difference in the incidence of pre-AS between the two groups (P = 0.394). Multivariate regression analysis showed that preoperative CCA was a cervical imaging factor affecting pre-AS (P = 0.011, odds ratio = 0.930), and other preoperative factors were not. The overall incidence of postoperative axial symptoms was 40.2% (41/102). The incidence of post-AS was 54.5% (24/44) in the traditional group and 29.3% (17/58) in the modified group. The incidence of post-AS was significantly different between the two groups (P = 0.010). The analysis showed that ML and CCA were the preoperative factors affecting post-AS (ML: P = 0.011, odds ratio = 0.302; CCA: P = 0.042, odds ratio = 0.947), and none of the other factors. Further analysis showed that patients with post-AS had smaller preoperative CCA (P = 0.043) than patients without post-AS. Anterior kyphosis angle is a risk factor for preoperative axial symptoms. Selection of patients with greater preoperative cervical kyphosis angle or application of mini-titanium plate fixation technique can reduce postoperative axial symptoms in patients with cervical spondylotic myelopathy undergoing open-door surgery. Part II Immediate changes in spinal and pelvic parameters are associated with improved quality of life in patients undergoing orthopedic scoliosis. Objective To compare and analyze the differences of spinal pelvic parameters and quality of life before and after surgery in adult patients with degenerative scoliosis, and to evaluate the correlation between immediate changes of spinal pelvic parameters and improvement of quality of life by univariate and multivariate linear regression analysis. The single-center database of orthopaedic surgery for scoliosis was retrospectively studied. Spinal and pelvic parameters included spinal coronal, spinal sagittal, and pelvic parameters. Spinal coronal parameters included maximum Cobb angle, coronal balance (CVA); spinal and pelvic sagittal balance included sagittal balance (SVA), lumbar lordosis (LL), and thoracic kyphosis. TK, PT, and SS. Quality of life was assessed using two questionnaires (ODI and VAS) to assess the degree of dysfunction and pain. Immediate changes in spinal and pelvic parameters (delta) and improvement in quality of life (delta) were defined separately. Matched t test and linear regression analysis were used for data statistics. Results A total of 52 patients met the criteria, including 13 males and 39 females. The mean follow-up time was 40 months (range, 25-78 months). The mean age at surgery was 56 years (range, 50-67 years). The mean fusion segment was 8.4 vertebral bodies (range, 5-11 vertebral bodies). The preoperative and postoperative spinal and pelvic parameters were at Cobb angle (P 0.001), SVA. (P = 0.001), LL (P 0.001), TK (P = 0.025), PT (P = 0.009) and S S (P = 0.007) showed significant differences, but CVA (P = 0.937) showed no significant difference. At the last follow-up, ODI and VAS scores were significantly improved compared with those before surgery (both P 0.001). Univariate regression analysis showed that delta SVA (P = 0.002), Delta LL (P = 0.002) and delta TK (P = 0.009) and delta O.009. Multivariate regression analysis showed that only SVA (P = 0.009) and LL (P = 0.016) remained significantly correlated with ODI, and TK (P = 0.581) was excluded. That is to say, ODI was expected to increase by 0.347 for every 1 mm increase in SVA, and 0.336 for every 1 degree increase in LL. Multivariate regression analysis showed that only SVA (P = 0.001) and LL (P = 0.046) remained significantly correlated with VAS, and TK (P = 0.926) was excluded. Spinal pelvic parameters (except CVA) and quality of life in patients with degenerative scoliosis. For adults with degenerative scoliosis, reduce S
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 楊曦;宋躍明;;脊柱-骨盆矢狀位曲度對(duì)腰椎退變性疾病的影響[J];中國(guó)脊柱脊髓雜志;2013年10期

2 邱勇;;重視成人脊柱畸形矯形中脊柱-骨盆矢狀面平衡的重建[J];中國(guó)脊柱脊髓雜志;2012年03期

3 鄭召民;劉輝;;脊柱-骨盆矢狀面平衡及其在成人脊柱畸形治療中的作用[J];中國(guó)脊柱脊髓雜志;2012年03期

4 陳光利;鮮軍舫;梁熙虹;;椎體成形術(shù)在急性粉碎性椎體骨折中的臨床應(yīng)用[J];中國(guó)醫(yī)學(xué)影像技術(shù);2009年09期

，

本文編號(hào)：2237520