摘要
[目的]比较短节段腰椎减压融合内固定术(PLIF)与动态固定系统(Dynesys)治疗退行性脊柱侧凸的围手术期并发症及临床疗效。[方法]回顾性分析本院2006~2015年所有的退变性腰椎侧弯矫形手术,病例纳入标准为Lenke-Silva Ⅱ级,根据采用的术式分为PLIF组33例,Dynesys组20例。其中男18例,女35例,平均年龄(57.3±6.9)岁(48~72岁)。固定2个节段的16例,3个节段的37例。分析术前与术后的腰椎侧凸Cobb角、VAS评分和ODI指数,以及手术时间、术中出血量、术后引流量等指标。两组之间使用独立样本t检验,置信区间为95%。[结果]PLIF组平均随访时间(28.2±14.9)个月,Dynesys组(29.2±12.0)个月。Dynesys组手术时间、术中出血量和术后引流量均少于PLIF组;PLIF组各种围手术期并发症发生率为33.33%,Dynesys组为20%。两组间差异有统计学意义(P<0.05)。PLIF组和Dynesys组VAS评分改善率分别为82.81%、80.60%,ODI指数改善率分别为77.80%、78.95%,两组间差异无统计学意义(P>0.05)。PLIF组和Dynesys组Cobb角矫形改善率分别为81.68%、74.78%,术后矫形丢失率分别为5.32%、18.34%,两组间差异有统计学意义(P<0.05)。[结论]Dynesys组手术时间、出血量、引流量、围手术期并发症均少许PLIF组。临床症状改善率与PLIF组相当。但矫形效果和腰椎稳定性不及PLIF组。
[Objectives] To compare the clinical outcomes and perioperative complications of posterior lumbar interbody fusion （PLIF） versus Dynesys for treatment of Lenke-Silva H degenerative scoliosis. [Methods] Fifty-three patients with degenerative scoliosis, all meeting the inclusion criteria of Lenke-Silva Ⅱ , were treated surgically from 2006 to 2015, including 18 males and 35 females, with an average age of （57.3±6.9） years old （range, 48 to 72 years） . Thirty-three of them underwent short segment decompression and fusion as PLIF group, and the other 20 patients received dynamic stabilization without fusion treatment as the Dynesys group. Two segments fixation was carried out in 16 cases while three segments was fixed in the remaining 37 cases. Perioperatively, the Cobb angle, VAS score, ODI index, operative time, blood loss and vol- ume of wound drainage were recorded and compared between two groups respectively. [Results] The mean follow-up time in the PLIF group and Dynesys group was （28.2±14.9） and （29.2± 12.0） months respectively. The operative time, blood loss and volume of wound drainage in the Dynesys group were less than those in the PLIF group. Perioperative complication rates in the PLIF group and Dynesys group were 33.3% versus 20%, with statistically significant difference between the two groups （P〈0.05） . The improvement rate of VAS score and ODI index had no statistically significant difference between groups （P〉 0.05） . The correction rate and loss of correction of lumbar scoliosis Cobb angle had significant differences between the two groups, the PLIF showed better correction outcome （P〈0.05） . [ Conclusion] Dynesys fixation has advantages of shorter op- erative time, less blood loss, less complications, whereas disadvantages of less maintaining of lumbar spine stability.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第13期1178-1183,共6页
Orthopedic Journal of China
关键词
脊柱侧凸
动态固定
椎管减压
degenerative scoliosis, dynamic stabilization, decompression
