| Objective:The trunk sagittal balance is mainly determined by the arrangement of the spine and pelvis,Spine and pelvic sagittal balance of the study is to develop the operation scheme 、 evaluation of orthopaedic surgery whether meet the requirements of mechanical、 important predictor of patients with postoperative quality of life.The lower lumbar spine including L3,4、L4,5、 L5,S1 three spine clearance, Spinal main bearing structure for the human body, Vertebra small joint and intervertebral disc of three joint complex is made up of a spinal motion segment, makes possible the cohesion of the vertebral body, maintain the stability of the spine and motor function.Intervertebral disc and the small joints of the lower lumbar spine degeneration and spine- the correlation of the pelvis in sagittal balance for scholars to carry on the proof, but the relationship between the biomechanics is relatively complex, with the spine- the correlation of the pelvis in sagittal balance, there is no clear conclusion. Lumbar degenerative disease is a common disease endangering human health and cause severe patients with lumbocruralpain symptoms and movement disorders, the serious influence the patient’s quality of life. Many scholars havestudide the cause of low back pain,butthe lumbar lordosis Angle and three joint complex biomechanics relationship with low back pain is controversial. Lumbar nerve decompression and internal fixation with bone graft fusion is one of the key principles in the clinical treatment of the disease. Along with the increase in Surgical cases, gradually found that it is not proportional to the improvement of convergence rate and clinical symptoms especially relief of symptoms of low back pain. Although achieved good fusion inmedical imaging, but it is not satisfied with low back pain symptoms recovery. This study intends to analyze relationship between sagittal balance and three composite joints of the lower lumbar spine.At the same time, research of lumbar spine pelvic parameters and impact on clinical efficacy of PLIF of the lower lumbar spine surgery, in order to provides the theory basis for the recovery of lumbar spine physiological curvature.This study is divided into the following three parts:The first, In 120 cases of volunteers and 59 cases with lumbar segmental line removal of nucleus pulposus, Cage bone graft fusion and internal fixation(PLIF) surgery patients, divided into normal group, the low back pain group and PLIF after surgery three groups were observed, Analysis of lumbar spinal sagittal balance relations with complex three joint degeneration.The second, In 120 cases of volunteers, the normal group, the low back pain group two groups were observed,Analysis of lumbar lordosis angle and three joints under complex relationship with low back pain.The third, This study follow-up in HENANKAIFENG lumbar PLIF surgery of 59 patients with lumbar degenerative disease, Observation analys Is of the lumbar spine pelvic parameters and impact on clinical efficacy of PLIF of the lower lumbar spine surgery, in order to provides the theory basis for the recovery of lumbar spine physiological curvature.Materials and methods1.According to the inclusion criteria to choose 120 cases of volunteers and fixed single segment of the lower lumbar spine fusion(PLIF) surgery 59 patients,a total of 179 cases of study all subjects(All subjects come form Kai Feng city of He Nan province). The normal group:Male 30 cases,Female 30 cases:aged 20 ~ 60 years old,The average age of 41.6 years.The low back pain group: Male 40 cases,Female 40 cases:aged 20 ~ 60 years old, The average age of 43.3 years;Low back pain course of 3 months ~ 84 months, an average of 15.7 months.The postoperative group: Lesions in the segments: 8 cases of L3、4,28 cases of L4、5, 23 cases of L5、S1,35 cases of lumbar disc prolapse,13 cases of lumbar disc combined lumbar spinal stenosis, 11 cases of degenerative lumbar olisthe(All patient with single segmental slippage and Meyerdingpoints for Ⅰdegrees). All patients aged between 20 ~ 60 years old, with an average age of 48.2 years; postoperative 6 months to 4 years,with an average age of 3.2 years. Statistical analysis of the normal group、the low back pain group and the measuring range of the parameters PLIF postoperative three groups、 each parameter average、standard deviation, Pfirrmann grading mean and standard deviation; PI to the normal group、the low back pain group L3,4、L4,5 and L5S1 small joint degeneration degree, the influence of PI and normal group, the low back pain group small joint degeneration 0 ~ Ⅰ level and Ⅱ ~ Ⅲ level the relationship between the two groups.2.The 120 volunteers were divided into normal group、the low back pain group two groups were observed,Analysis of lumbar lordosis Angle and three joints under complex relationship with low back pain.Analysis of normal men and women the 30 cases, normal group of different age groups and two groups of volunteers in different segment Pfirrmann grading、Pathria classification and LL mean, low back pain group lordosis Angle and the relationship between low back pain VAS score.3.Follow-up of lumbar PLIF surgery of 59 patients with degenerative disease of the lumbar spine, we analyzed retrospectively the lumbar spine pelvic parameters and impact on clinical efficacy of PLIF of the lower lumbar spine surgery. Respectively analysis of 8 cases、28 cases、23 cases of L3,4、L4,5、L5, S1 intervertebral disc PLIF surgical LL、ULL different time points and the ’LLL average, PLIF 59 cases with lumbar spine surgery preoperative and postoperative march and low back pain JOA score at the time of the last follow-up analysis.Statistical analysis was performed using SPSS17.0 statistical software package(SPSS, USA). single factor analysis of variance( One_Way ANOVA) and repeated measurement ANOVA were used for measurement data, Every two groups were compared by the method of SNK;Non parametric test was used for count data; Two-side p value<0.05 was considered stastically significant.The test results1.1 There was no statistically significant difference comparing the average SVA three groups. Postoperative group and normal group、the group compared with low back pain group, PI、LL、PT and SS average increase, P < 0.05, with statistical significance.1.2 According to measured PI normal range, the normal group and low back pain group is divided into A、B、C three groups respectively. Normal group A、B、C quantity respectively: 9 cases、41 cases、10 cases; Low back pain group A、B、C number respectively is: 12 cases、42 cases、6 cases; PLIF group without postoperative cases in group A. For group PLIF postoperative intervertebral disc has been fusion, only L3, 4、L4, 5 and L5,S1 among 51, 21 and 26 disc observation points B and C two groups. Found in the normal group and low back pain group of L4, 5 intervertebral disc degeneration grades higher than that of L3, 4 and L5,S1. A group of intervertebral disc degeneration level is significantly higher than B, C in the two groups. PLIF postoperative disc degeneration level lower than that of low back pain between groups.1.3 Because of PLIF postoperative group because nail bar system to the destruction of the articular process of joint, is not easy to assess. Observe size and articular process PI Angle joint degeneration, the relationship between the normal group and the combination of low back pain and observe for statistical analysis. Based on the measured PI normal range is divided into A、B、C three groups. A: 21 cases; B: 83; C: 16 cases. Found in group A L4, 5 and L5,S1 level Ⅱ ~ Ⅲ joints degeneration grade average proportion were significantly higher than that of B,C two groups.2.1 Men and women all 30 cases of normal group, measured Pfirrmann grading、 Pathria classification and lumbar LL mean. Pfirrmann grading mean: male is 3.15; Women was 2.91. Pathria grade average: male is 2.34; Women was 2.01.Degeneration of intervertebral disc and articular process classification men are higher than women, but P > 0.05, there was no statistically significant difference. Lumbar LL mean: men at 50.15 and women at 54.64, of the male than female group(P < 0.05, with statistical significance.2.2 60 cases of normal group by age 20 ~ 30 years、30 ~ 40 years old、 40 ~ 50 years、50 ~ 60 years old is divided into four groups, measured Pfirrmann grading、 Pathria classification and lumbar LL mean. After statistical analysis found that the Pfirrmann grading, Pathria grade average increases with age, with gradually increasing trend, but two contrast has no statistical significance.2.3 Compared with 60 cases of normal group and 60 patients with low back pain Pfirrmann grading、 Pathria classification and lumbar LL mean. Low back pain group of L3, 4 segment Pfirrmann grading、Pathria grading were higher than in normal group, but there is no obvious statistical significance. Low back pain group of L4, 5、L5, S1 intervertebral disc Pfirrmann grading averages, L4,5 articular joint Pathria grade average significantly greater than the normal group, with statistical significance. Low back pain of lumbar LL is less than the normal group, with statistical significance.2.4 low back pain group lordosis Angle and the relationship between low back pain VAS, according to the average of 52.0 ° of the lumbar lordosis Angle, divided into acuity 39.9°(28 cases), < 39.9°(31 cases) in the two groups; The result shows: the P group of VAS scoring average of 3.94, < 39.9 ° VAS scoring average of 4.69, comparing the two groups(P < 0.05, with statistical significance. Lumbar lordosis Angle and negatively correlated with low back pain, pain worse with the decrease of the lumbar lordosis Angle.3.1 L3, 4、 L4, 5 and L5,S1 fou respectively single segmental PLIF surgical 8 cases、28 cases and 23 cases. March and the last measured preoperative and postoperative follow-up of LL, ULL name LLL and average + /- standard deviation. L3, 4, and L4, 5 measured LL, ULL and name LLL preoperative and postoperative visit march average increase obviously, P < 0.05, with statistical significance. The postoperative 3 months at the time of the last follow-up after LL, ULL and name ’LLL degree average decreases, and compared the two no obvious statistical significance.L5, S1 LL, ULL and measured the name ’LLL the mean preoperative and postoperative visit in March, compared to the mean of no statistical significance(P > 0.05).3.2 59 cases with lumbar PLIF surgical evaluation of preoperative and postoperative respectively in March and the JOA score at the time of the last follow-up. All cases of postoperative JOA scores were compared with preoperative march increased greatly, the comparison with statistical significance. The postoperative 3 months at the time of the last follow-up has obviously improved, which shows no obvious statistical significance.3.3 All patients were followed up, time of postoperative follow-up 6 months to 4 years. Only L5 and S1 are 1 case after September 1 screw screw breakage, found no fusion is loose, good intervertebral fusion, postoperative remove nail rod system in December. Lumbar posterior correction PLIF surgical operation in curvature of the lower lumbar spine clinical effect is good, the apparent recovery lumbar curve, intervertebral height recovery, reduce the incidence of fracture, nail bar system in patients with low back pain symptoms improved significantly.Conclusion1.Research on low back pain and lumbar surgery group- the changing rule of the parameters of the pelvis in sagittal spine. Studies have shown that L4, 5、 L5, S1 is L3, 4 prone to intervertebral disc degeneration, intervertebral disc degeneration degree negative correlation with the value of PI, PI value more hours are more likely to appear of intervertebral disc degeneration. L4, 5 articular process joint the L3, 4 and L5,S1 prone to degeneration; PI value smaller joints joint degeneration of higher grade, articular process and PI values were negatively associated with the degree of degeneration of the joints.2.Found women significantly greater than the male lumbar lordosis Angle, no difference between the three joint complex degree of degeneration. Lumbar lordosis Angle in different age groups, no difference between the three composite joint degeneration, but along with the age growth, has a tendency to overall degeneration is aggravating, conform to the laws of nature. Low back pain of lumbar lordosis Angle is much smaller than normal group, L4, 5 three composite joints degenerative levels higher than normal group, L5, S1 intervertebral disc degeneration grade higher than the normal group, no difference between the articular process of joint degeneration. Lumbar lordosis Angle is smaller, the more obvious low back pain symptoms.3.PLIF L3, 4, and L4, 5 lumbar lordosis Angle than the mean preoperative increased obviously; L5,S1 lumbar lordosis Angle there was no significant difference in March compared with the preoperative. JOA score significantly higher, low back pain symptoms were improved significantly. |
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