单纯椎管减压术与椎管减压合并内固定融合术治疗退变性脊柱侧凸的前瞻性随机对照研究  

Decompression combined with or without fusion for degenerative scoliosis: a prospective,randomized controlled trial study

作　　者：耿晓鹏[1] 孙磊[2] 王霞[3] 李建军[1] 李雪城 付国勇[1] 高升[1] 朱锴[1] 

机构地区：[1]滨州医学院附属医院,山东滨州256603 [2]解放军第88医院,山东泰安271000 [3]山东滨州市人民医院256610

出　　处：《中国矫形外科杂志》2016年第13期1158-1163,共6页Orthopedic Journal of China

基　　金：山东省医药卫生科技发展计划项目(编号:2013WS0300)

摘　　要：[目的]采用前瞻性随机对照试验的方法比较单纯椎管减压术与椎管减压合并内固定融合术治疗退变性脊柱侧凸的短期疗效,为制定手术方案提供依据。[方法]2012年11月～2014年2月,对62例符合纳入标准的退变性脊柱侧凸患者进行前瞻性随机对照试验研究。将符合纳入标准的患者分别随机选入A组或B组,A组采用单纯椎管减压术治疗,减压方法为潜行减压。B组采用减压合并内固定融合术治疗。A组共30例（其中男6例,女24例）,B组共32例（其中男8例,女24例）。记录两组患者临床及随访的数据资料,采用SPSS 17.0对数据进行统计学分析。[结果]术后随访15～24个月,平均19个月。两组术后3个月冠状面Cobb角平均值与术前比较,差异有统计学意义（P〈0.001）;末次随访冠状面Cobb角与术后3个月比较,差异无统计学意义,两种手术末次随访与术后3个月比较Cobb角变化差异无统计学意义。A组术后Cobb角矫正率为（42±25）%;B组为（59±28）%,B组平均值高于A组,且差异有统计学意义（P〈0.001）。所有患者术后临床症状均逐渐缓解,两组患者术后3个月与术前比较,末次随访与术后3个月比较,ODI、VAS数值均逐渐减小,P值均〈0.001,差异有统计学意义。B组术中失血量、手术时间、住院天数、下床时间、并发症例数均高于A组,且差异有统计学意义。随访期间两种手术后患者的临床症状逐渐改善,Cobb角均无加重趋势。[结论]采用潜行减压的方法单纯椎管减压术和椎管减压合并内固定融合术均是治疗退变性脊柱侧凸安全有效的手术方法;但单纯椎管减压术创伤小、术中失血少、手术时间短、下床及住院时间短、并发症发生少,椎管减压合并内固定融合术有较高的Cobb角矫正率。采用潜行减压可以有效避免减压节段的不稳定,防止减压节段侧凸程度的进展;采用椎管减压合并内固定融合术可以保证充分减[Objective] To evaluate the outcomes of decompression with or without fusion in the treatment of degenerative scoliosis（ DS） with a prospectively randomized controlled trial study. [Methods] A total of 62 patients with degenerative scoliosis received surgical treatment from November 2012 to February 2013,and patients were divided into two groups according to the decompression with or without fusion. In Group A,30 patients were treated without fusion and in group B,another 32 patients received decompression with fusion by internal fixation. Intraoperative data collection included surgical procedural details,operative time,hospital stays,estimated blood loss,and surgical complications. The preoperative demographic data and the postoperative follow- up data,including age,sex,Cobb angle,ODI（ Oswestry Disability Indexes）,VAS（ Visual Analogue Scale / Score）,were also been compared in our study. [Results] All patients obtained follow- up for 15 to 24 months postoperatively（ mean,19 months）. The difference of the Cobb scoliosis angles three months after operation between two groups was statistically significant（ P〈0. 01）,and the difference of the Cobb scoliosis angles at three months after operation and at last follow- up in every group was not statistically significant（ P〉0. 01）,while the correction rate of Cobb angle was（ 59 ± 28） % in the fusion group, signifiantly higher than（ 42 ± 25） % in the decompression- only group. Oswestry Disability Indexes and Visual Analogue Scores improved significantly from pre- operation to three months after operation and from three months after operation to the last follow- up in the two groups（ P〈0. 01）. There were significant differences between the two groups in operative blood loss,operative time,hospital stays,and surgical complications（ P〈0. 01）. [Conclusion] Both the decompression- only and decompression with fusion are safe and effective operations to degenerative scoliosis patients. The decompression- only has advantages of les

关 键 词：退变性 脊柱侧凸 椎管减压 内固定融合 

分 类 号：R687.3[医药卫生—骨科学]