Objective: To present efficacy of clinical application of a classification based on crucial curvature of coronal imbalance in degenerative lumbar scoliosis (DLS). Methods: A case series study. Clinical data of 61 cases (8 males, 53 females) who underwent posterior correction surgery for DLS from January 2019 to January 2021 were retrospectively analyzed. The mean age was (71.7±6.2) years (ranged 60-82 years). According to the direction of C₇ plumb line (C₇PL) deviated from central sacral vertical line (CSVL) and orientation of L₄ coronal tilt, the author determined which one was the crucial curve. If C₇PL deviated from CSVL in the same direction as concave side of the thoracolumbar curve and L₄ coronally tilts opposite direction of C₇PL deviates from CSVL, then the crucial curve was thoracolumbar curve (type 1). On the contrary, if C₇PL deviated from CSVL in the same direction as concave side of the lumbosacral curve and L₄ coronally tilts consist with direction of C₇PL deviates from CSVL, then the crucial curve was lumbosacral curve (type 2). According to absolute value of coronal balance distance (|CBD|), each type of patients was divided into two groups, respectively, namely coronal balance (CB) (|CBD|≤3 cm) and coronal imbalance (CIB) (|CBD|>3 cm). Changes of Cobb angles of thoracolumbar curve and lumbosacral curve and CBD were recorded and analyzed. Results: The rate of preoperative CIB was 55.7% (34/61) in all the patients. Of the patients, 23 cases were classified as type 1 and 38 cases as type 2. The rate of preoperative CIB was 34.8% (8/23) in type 1 patients and 68.4% (26/38) in type 2. The rate of postoperative CIB was 27.9% (17/61) in all the patients, with 13.0% (3/23) in type 1 and 36.8% (14/38) in type 2. The |CBD| of CB group in type 1 patients decreased from (2.6±1.4) cm before the operation to (1.5±1.0) cm after (P=0.015); and the correction rate of thoracolumbar curve (68.8%±18.4%) was significantly higher than that of lumbosacral curve (34.5%±23.9%) (P=0.005). The |CBD| of CB group in type 2 patients decreased from (2.6±3.0) cm before the operation to (1.6±1.2) cm after (P=0.027); the correction rate of lumbosacral curve (71.3%±18.6%) was higher than that of thoracolumbar curve (57.3%±21.1%), but the difference was not statistically significant (P=0.546). There was no significant difference in |CBD| of CIB group in type 2 patients before and after the operation (P=0.222); the correction rate of lumbosacral curve (38.3%±14.8%) was significantly lower than that of thoracolumbar curve (53.6%±16.0%) (P=0.001). There was a correlation between the change of CBD (3.8±1.5) cm and the difference in correction rate between thoracolumbar and lumbosacral curve (32.3%±19.6%) in CB group in type 1 patients after surgery (r=0.904, P<0.001). There was a correlation between the change of CBD (1.9±2.2) cm and the difference in correction rate between lumbosacral and thoracolumbar curve (14.0%±26.2%) in CB group in type 2 patients after surgery (r=0.960, P<0.001). Conclusion: Clinical application of a classification based on crucial curvature of coronal imbalance in DLS is satisfactory, and its combination with matching correction can effectively prevent the occurrence of coronal imbalance after spinal correction surgery.

目的： 介绍一种基于核心弯的退变性腰椎侧凸冠状面失衡分型方法的临床应用效果。 方法： 病例系列研究。回顾性分析2019年1月至2021年1月在首都医科大学宣武医院行后路脊柱矫形手术的61例退变性腰椎侧凸患者的临床资料，其中男8例，女53例，年龄（71.7±6.2）岁（60~82岁）。根据冠状面C₇铅垂线（C₇PL）偏离骶骨正中线（CSVL）的方向以及L₄椎体倾斜方向来判断核心弯：若C₇PL的偏离CSVL方向与胸腰弯凹侧一致，L₄椎体倾斜方向与C₇PL偏离CSVL方向相反，则胸腰弯为核心弯，定义为1型；若C₇PL偏离CSVL的方向与腰骶弯凹侧一致，L₄椎体倾斜方向与C₇PL偏离CSVL方向一致，则腰骶弯为核心弯，定义为2型。根据冠状面平衡距离（CBD）的绝对值（|CBD|）分别将每一型患者分为两组，即|CBD|≤3 cm的平衡组（CB）与|CBD|>3 cm的失衡组（CIB）。记录并分析术前术后胸腰弯Cobb角、腰骶弯Cobb角以及CBD变化。 结果： 61例患者（1型23例，2型38例）中术前冠状面失衡发生率为55.7%（34/61），1型中为34.8%（8/23），2型中为68.4%（26/38），术后冠状面失衡发生率为27.9%（17/61），1型组为13.0%（3/23），2型组为36.8%（14/38）。1型术后CB组|CBD|为（1.5±1.0）cm，较术前的（2.6±1.4）cm减小（P=0.015）；胸腰弯的矫正率为68.8%±18.4%，明显大于腰骶弯的矫正率（34.5%±23.9%），差异有统计学意义（P=0.005）。2型术后CB组|CBD|为（1.6±1.2）cm较术前的（2.6±3.0）cm明显减小（P=0.027）；腰骶弯的矫正率为71.3%±18.6%，大于胸腰弯的57.3%±21.1%，但差异无统计学意义（P=0.546），2型术后CIB组|CBD|与术前差异无统计学意义（P=0.222），腰骶弯的矫正率为38.3%±14.8%，小于胸腰弯的53.6%±16.0%，差异有统计学意义（P=0.001）。1型术后CB组患者CBD变化（3.8±1.5）cm与两弯矫正率之差（32.3%±19.6%）存在相关性（r=0.904，P<0.001）。2型术后CB组CBD变化（1.9±2.2）cm与两弯矫正率之差（14.0%±26.2%）存在相关性（r=0.960，P<0.001）。 结论： 基于核心弯的退变性腰椎侧凸冠状面失衡分型的临床应用效果满意，其结合匹配矫正理念可有效预防脊柱矫形术后冠状面失衡的发生。.