摘要
目的比较减压联合长、短节段固定治疗Cobb角20~40°的退变性脊柱侧弯(degenerative scoliosis,DS)并椎管狭窄的疗效。方法回顾分析2015年1月-2017年5月采用后路减压椎弓根螺钉长、短节段固定融合术治疗的50例Cobb角20~40°的DS患者临床资料,分为长节段组(固定节段>3个)23例和短节段组(固定节段≤3个)27例。两组患者性别、年龄、病程及术前下肢痛疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、胸椎后凸角(thoracic kyphosis,TK)、胸腰椎后凸角(thoracolumbar kyphosis,TLK)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic title,PT)、骶骨倾斜角(sacral slope,SS)比较,差异均无统计学意义(P>0.05);但长节段组术前下腰痛VAS评分、冠状面Cobb角、脊柱矢状面平衡(sagittal vertical axis,SVA)显著高于短节段组(P<0.05),腰椎前凸角(lumbar lordosis,LL)显著小于短节段组(t=2.427,P=0.019)。记录并比较两组患者手术时间、术中出血量、术中透视次数、住院时间及并发症发生情况。术前及末次随访时采用下肢痛、下腰痛VAS评分和ODI评分评价临床疗效,并比较两组患者手术前后评分以及改善值。术前、术后6个月及末次随访时测量各脊柱-骨盆参数。结果短节段组手术时间、术中出血量、术中透视次数明显少于长节段组(P<0.05);两组住院时间比较差异无统计学意义(t=0.933,P=0.355)。两组患者均获随访,随访时间12~46个月,平均22.3个月。末次随访时,患者下腰痛VAS评分、下肢痛VAS评分和ODI评分均较术前显著改善(P<0.05);两组间除末次随访时下腰痛VAS评分改善值比较差异有统计学意义(t=8.332,P=0.000)外,其余各评分及其改善值比较差异均无统计学意义(P>0.05)。与术前比较,长节段组术后各时间点Cobb角、SVA、TLK、PT显著减小,SS和LL显著增大(P<0.05);而短节段组仅Cobb角、PT显著减小,SS显著增大(P<0.05);两组末次随访时与术后6个月时各脊柱-骨盆参数比较,差异均无统计学意义(P>0.05)。末次随访时,长节段组Cobb角、SVA、LL、PT以及SS改善值显著高于短节段组(P<0.05)。两组均无围术期死亡;长节段组并发症发生率为34.8%(8/23),显著高于短节段组11.1%(3/27)(χ~2=4.056,P=0.034)。结论对于Cobb角20~40°的DS患者,根据不同退变程度选择不同固定节段均可获得较好的生活质量改善,其中短节段固定创伤更小、并发症更少,而长节段固定在改善脊柱-骨盆参数和缓解下腰痛方面更具优势。
Objective To compare the effectiveness of decompression and short fusion or long fusion for degenerative scoliosis(DS)with a Cobb angle of 20-40°combined with spinal stenosis.Methods The clinical data of 50 patients with DS who were treated with decompression combined with short fusion or long fusion between January 2015 and May 2017 were retrospectively analysed.Patients were divided into long fusion group(fixed segments>3,23 cases)and short fusion group(fixed segments≤3,27 cases).There was no significant difference in gender,age,disease duration,and preoperative visual analogue scale(VAS)score of leg pain,Oswestry disability index(ODI),thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),pelvic incidence(PI),pelvic title(PT),and sacral slope(SS)between the two groups(P>0.05);however,the VAS score of low back pain,Cobb angle,and sagittal vertical axis(SVA)in long fusion group were significantly higher than those in short fusion group(P<0.05),and the lumbar lordosis(LL)was significantly lower than that in short fusion group(t=2.427,P=0.019).The operation time,intraoperative blood loss,fluoroscopy times,hospital stay,and complications were recorded and compared.The VAS scores of low back pain and leg pain and ODI score were used to evaluate the clinical outcomes before operation and at last follow-up.X-ray films of the whole spine in standard standing position were taken before operation,at 6 months after operation,and at last follow-up,and the spino-pelvic parameters were measured.Results The operation time,intraoperative blood loss,and fluoroscopy times in the short fusion group were significantly less than those in the long fusion group(P<0.05);there was no significant difference in hospital stay between the two groups(t=0.933,P=0.355).The patients were followed up 12-46 months with an average of22.3 months.At last follow-up,the VAS scores of low back pain and leg pain and ODI score significantly improved when compared with those before operation(P<0.05).Except for the improvement of VAS score of low back pain(t=8.332,P=0.000),the differences of the improvements of the other scores between the two groups were not significant(P>0.05).The Cobb angle,SVA,TLK,and PT significantly decreased,while SS and LL significantly increased in the long fusion group(P<0.05),while the Cobb angle and PT significantly decreased and SS significantly increased in the short fusion group at last follow-up(P<0.05).There was no significant difference in spino-pelvic parameters between the two groups at6 months after operation and at last follow-up(P>0.05).The improvements of Cobb angle,SVA,LL,PT,and SS in the long fusion group were significantly higher than those in the short fusion group at last follow-up(P<0.05).There was no perioperative death in both groups.The incidence of complications in the long fusion group was 34.8%(8/23),which was significantly higher than that in the short fusion group[11.1%(3/27)](χ~2=4.056,P=0.034).Conclusion The DS patients with the Cobb angle of 20-40°can achieve satisfactory clinical outcomes and improve the spino-pelvic parameters by choosing appropriate fixation levels.Short fusion has less surgical trauma and fewer complications,whereas long fusion has more advantages in enhancing spino-pelvic parameters and relieving low back pain.
作者
李远强
欧云生
朱勇
赵增辉
罗伟
徐帅
余浩洋
LI Yuanqiang;OU Yunsheng;ZHU Yong;ZHAO Zenghui;LUO Wei;XU Shuai;YU Haoyang(Department of Orthopedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第3期285-293,共9页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81572634)。
