摘要
目的探讨经椎弓根固定治疗退行性脊柱侧凸(degenerative scoliosis,DS)合并椎管狭窄(spinal stenosis,SS)的临床疗效。方法回顾性分析2018年1月~2021年12月行减压联合后路椎弓根固定治疗的110例DS并SS患者的临床资料,根据固定椎体个数分为长节段组(n=57,固定节段>3个),短节段组(n=53,固定节段≤3个)。比较两组患者围术期、随访和影像学资料。结果两组患者年龄、性别、病程、主弯方向和骨质疏松症患病率方面比较,差异无统计学意义(P>0.05)。长节段组患者住院时间、手术时间及术中出血量大于短节段组(P<0.05)。与术前比较,末次随访时,两组患者腰痛视觉模拟(visual analogue scale,VAS)评分、下肢痛VAS评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评分减少(P<0.05);组间比较,末次随访时,长节段组患者各评分均低于短节段组(P<0.05)。与术前比较,末次随访时,两组患者侧凸Cobb角、骨盆倾斜角(pelvic title,PT)、矢状面平衡(sagittal vertical axis,SVA)减小,LL增大(P<0.05);组间比较,末次随访时,长节段组患者侧凸Cobb角、LL、PT、SVA小于短节段组,LL大于短节段组(P<0.05)。末次随访时,两组患者椎间融合区域均实现骨性融合。长节段组和短节段组患者的并发症发生率分别为28.07%(16/57)和11.32%(6/53),差异有统计学意义(χ^(2)=4.815,P=0.028)。结论在手术方式选择合适的情况下,经椎弓根固定治疗DS合并SS能够取得较好的临床疗效。长节段固定在恢复脊柱平衡、改善临床症状方面效果更好,短节段固定手术创伤更小、手术时间更短、手术并发症发生率更低,应在对患者综合评估后选择手术方案。
Objective To investigate the clinical efficacy of transpedicle fixation in the treatment of degenerative scoliosis(DS)combined with spinal stenosis(SS).Methods The clinical data of 110 patients with DS and SS who were treated with decompression combined with posterior pedicle fixation from January 2018 to December 2021 were retrospectively analyzed.According to the number of fused vertebrae,the patients were divided into long-segment group(n=57,fixed segments>3)and short-segment group(n=53,fixed segments≤3).The perioperative,follow-up and imaging data were compared between the two groups.Results There were no significant differences in age,gender,course of disease,the direction of main curvature and prevalence of osteoporosis between the two groups(P>0.05).The length of hospital stay,operative time and intraoperative blood loss in the long-segment group were longer than those in the short-segment group(P<0.05).Compared with pre-operation,the visual analogue scale(VAS)score of lumbago,the VAS score of melosalgia and Oswestry disability index(ODI)were decreased in both groups at the last follow-up.The scores of the long-segment group were lower than those of the short-segment group at the last follow-up(P<0.05).Compared with pre-operation,the Cobb angle,pelvic title(PT)and sagittal vertical axis(SVA)were decreased and LL was increased in both groups at the last follow-up(P<0.05).The Cobb angle,LL,PT and SVA were smaller and the LL was larger in the long-segment group than those in the short-segment group at the last follow-up(P<0.05).At the last follow-up,bone fusion was achieved in the interbody fusion area in both groups.The incidence of complications in the long-segment group and the short-segment group was 28.07%(16/57)and 11.32%(6/53),respectively,with statistically significant differences(χ^(2)=4.815,P=0.028).Conclusion In the case of appropriate surgical methods,transpedicular fixation for DS combined with SS has achieved good clinical effect.Long-segmental fixation in restore spinal balance and improve the clinical symptoms effect is better,short-segmental fixation has less trauma,shorter operation time and lower complication incidence.The surgical plan should be selected after the comprehensive evaluation of the patients.
作者
席健伟
刘磊
刘光普
韩猛
卜晋辉
王鑫宇
苏超凡
马超
XI Jianwei;LIU Lei;LIU Guangpu(Affiliated Xuzhou Clinical College of Xuzhou Medical University,Jiangsu 221009,China)
出处
《医学研究杂志》
2024年第8期150-154,共5页
Journal of Medical Research
基金
江苏省卫生健康委员会科研项目(Z2022040)
江苏省徐州市医学重点人才培养项目(XWRCHT20220050)。
关键词
退行性脊柱侧凸
椎管狭窄
减压术
外科
脊柱融合术
Degenerative scoliosis
Spinal stenosis
Decompression,surgical
Spinal fusion
