摘要
[目的]比较长节段与短节段固定治疗老年退变性脊柱侧弯(degenerative scoliosis,DS)临床效果。[方法]回顾性分析本院手术治疗DS的112例患者的临床资料,其中,58例采用长节段固定融合(长节段组),54例采用短节段组接受短节段固定融合(短节段组)。比较两组患者围手术期、随访及影像学资料。[结果]两组均顺利完成手术,术中均无严重并发症。长节段组手术时间、术中出血量、切口长度、透视次数及融合节段数均显著大于短节段组(P<0.05)。总体并发症,长节段组为18.97%(11/58),短节段组为5.55%(3/54),差异有统计学意义(P<0.05)。与术前相比,末次随访时两组患者的腰痛、下肢痛VAS评分,以及0DI评分均显著下降(P<0.05)。末次随访时,长节段组腰痛和腿痛VAS以及ODI评分均显著低于短节段组(P<0.05)。影像方面,与术前相比,末次随访时两组患者侧凸Cobb角、CBD、SVA和PT均显著减少(P<0.05),而LL均显著增加(P<0.05)。末次随访时长节段组在侧凸Cobb角、CBD、SVA、LL和PT的矫正方面均优于短节段组(P<0.05)。[结论]对于老年DS,短节段固定融合手术创伤小,而长节段固定融合临床效果与影像矫正更优,应依据患者实际病情灵活选择。
[Objective]To compare the clinical outcomes of long-segment and short-segment instrumented fusion in the treatment of senile degenerative scoliosis(DS).[Methods]A retrospective study was conducted on 112 patients who underwent surgical treatment for DS in our hospital.Among them,58 patients were treated with long-segment intrumented fusion,while 54 patients received short-segment instrumented fusion.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]All the patients had operation performed smoothly without serious complications during the operation.The long-segment group was significantly greater than the short-segment group in operation time,intraoperative blood loss,incision length,number of fluoroscopy and the number of fused segments(P<0.05).The overall complications were 18.97%(11/58)in the long-segment group,whereas 5.55%(3/54)in the short-segment group,which was statistically significant(P<0.05).Compared with those preoperatively,the VAS scores of low back pain and lower limb pain,as well as ODI score significantly decreased in both groups at the latest follow-up(P<0.05).The long-segment group proved significantly superior to the short-segment group in the VAS scores of low back pain and leg pain,as well as the ODI at the latest follow-up(P<0.05).In terms of imaging evaluation,the Cobb angle,CBD,SVA and PT significantly reduced,while LL was significantly increased in both groups at the latest follow-up compared with those before operation(P<0.05).At the latest follow-up,the long-segment group was significantly superior to the short-segment group regarding to correction of scoliosis Cobb angle,CBD,SVA,LL and PT(P<0.05).[Conclusion]For DS in the elderly,short-segment instrumented fusion is less traumatic,while long-segment fusion has better clinical outcomes and correction on radiographs,which should be flexibly selected according to the actual condition of the patient.
作者
潘承波
徐淑珍
孙健
王永康
李严涛
李嗣生
PAN Cheng-bo;XU Shu-zhen;SUN Jian;WANG Yong-kang;LI Yan-tao;LI Si-sheng(Department of Spine Surgery,Zibo Orthopedic Hospital,Zibo 255040,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2021年第23期2144-2148,共5页
Orthopedic Journal of China
基金
山东省医药科技项目(编号:20180868)。
关键词
退变性脊柱侧弯
后路手术
减压融合固定
长节段
短节段
degenerative scoliosis
posterior surgery
instrumented fusion
long segment
short segment
作者简介
潘承波,副主任医师,研究方向:脊柱外科及脊柱微创外科,电话:13581009840,电子信箱:panchengbo0409@163.com;通信作者:李嗣生,电话:13853357315,电子信箱:lisisheng2212@sina.com。
