后路减压联合不同融合节段固定治疗退变性脊柱侧凸疗效分析  

Clinical effects of posterior decompression combined with short versus long segment fusion in degenerative scoliosis

作　　者：张国友[1] 李明[1] 朱晓东[1] 白玉树[1] 王传锋[1] 赵颖川[1] 吴大江[1] 

机构地区：[1]第二军医大学长海医院骨科,上海200433

出　　处：《脊柱外科杂志》2011年第6期337-341,共5页Journal of Spinal Surgery

摘　　要：目的比较后路减压联合短节段或长节段融合对退变性脊柱侧凸的治疗效果。方法回顾分析随访2年以上退变性脊柱侧凸患者44例,均行后路减压椎弓根螺钉固定融合手术,根据融合范围分为短节段组和长节段组。记录2组患者术前、术后即刻、末次随访的影像学参数和Oswestry功能障碍指数(Oswestry disabiliby index,ODI)评分。结果 2组平均融合节段分别为2.8和5.8个,差异有统计学意义(P<0.01)。术前短节段组平均侧凸Cobb角为15.9°,长节段组为23.5°;术后Cobb角矫正率分别为23%和61%,手术前后差异有统计学意义(P<0.01)。长节段较短节段融合对冠状面失平衡和侧方滑脱改善明显,但2种手术方式对腰椎前凸及矢状面失平衡矫形效果无显著差异。长节段融合早期并发症较短节段融合高。2组患者手术前后ODI评分无明显差异。结论侧凸Cobb角较小、保持良好脊柱平衡的退变性脊柱侧凸患者可选择后路减压联合短节段融合手术,Cobb角较大或严重侧方滑脱的患者选择长节段融合可提高矫形效果,严重矢状面失衡的患者可考虑行截骨矫形手术。Objective To compare the surgical outcomes of posterior decompression combined with short or long segment fusion of the patients with degenerative scoliosis.Methods Clinical data of 44 patients,who were treated by posterior decompression and fusion with pedicle screws and followed up over 2 years,were retrospectively analyzed.According to the range of fusion,these patients were divided into short segment group and long segment group.The radiological parameters and Oswestry disability index（ODI） scores of all the patients were recorded before surgery,after surgery,and at the final follow-up.Results There were 2.8 and 5.8 segments of fused vertebrae on average in short segment group and long segment group,respectively.And the difference had statistical significance（P0.01）.The preoperative average Cobb＇s angle was 15.9° in short segment group and 23.5° in long segment group.The correction rates of Cobb＇s angle were 23% and 61% in the 2 groups with a statistical difference（P0.01）.Compared with short segment fusion,coronal imbalance and lateral olisthe were significantly improved by long segment fusion.However,there was no significant difference in the correction of lumbar lordosis and sagittal imbalance between the 2 groups,and neither was the difference of ODI scores before surgery and at the final follow-up.The incidence rate of early complications in long segment group was higher than that in short segment group.Conclusion Short segment fusion is suitable for the patients with small Cobb＇s angle and good spinal balance.For the patients with large Cobb＇s angle or severe lateral olisthe,long segment fusion can improve the correction effects.Spinal osteotomy may be considered for severe sagittal imbalance.

关 键 词：脊柱侧凸 减压术 外科 内固定器 骨移植 脊柱融合术 

分 类 号：R682.3[医药卫生—骨科学]