伴B型和C型冠状面失平衡的退变性脊柱侧凸患者后路截骨矫形术后临床疗效比较  

Comparison of clinical outcomes between type B and type C coronal pattern patients with degenerative scoliosis

作　　者：王玉 刘盾 石博 史本龙 王斌[1] 刘臻[1] 孙旭[1] 钱邦平[1] 朱泽章[1] 邱勇[1] Wang Yu;Liu Dun;Shi Bo;Shi Benlong;Wang Bin;Liu Zhen;Sun Xu;Qian Bangping;Zhu Zezhang;Qiu Yong(Department of Spine Surgery,Nanjing Drum Tower Hospital,Clinical College of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院脊柱外科,南京210008

出　　处：《中华医学杂志》2020年第11期842-847,共6页National Medical Journal of China

基　　金：江苏省自然科学基金青年基金(BK20170126)。

摘　　要：目的比较伴有B型和C型冠状面失平衡的退变性脊柱侧凸(DS)患者行后路截骨矫形术后临床疗效及生活质量的差异。方法回顾性分析2010年3月至2017年8月于南京鼓楼医院脊柱外科行脊柱后路截骨矫形内固定术的伴有冠状面失平衡DS患者的临床资料。于术前、术后即刻和末次随访时的站立位全脊柱正、侧位X线片上测量主弯Cobb角、冠状面躯干偏移(CI)、腰椎前凸角(LL)、最大后凸角(GK)、矢状面平衡(SVA)。于术前及末次随访时填写疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及健康调查问卷简表(SF-36)。组间资料的比较采用独立样本t检验。结果共38例患者入选本研究,平均年龄(60±6)岁,平均随访(31±10)个月。其中B型24例,C型14例。两组患者年龄、性别、截骨方式、随访时间、术前CI、LL、GK、SVA等均无明显统计学差异(均P>0.05)。B型组术前主弯Cobb角平均44°±19°,术后降至19°±7°(t=8.496,P<0.001),末次随访时为19°±6°,未见明显矫正丢失(t=-0.657,P=0.518);C型组术前主弯Cobb角平均43°±9°,术后降至21°±4°(t=13.537,P<0.001),末次随访时为21°±5°,亦未见明显矫正丢失(t=-0.186,P=0.856)。两组间术前、术后及末次随访时主弯Cobb角差异均无统计学意义(均P>0.05)。两组术后冠状面躯干偏移均较术前显著下降,末次随访时维持良好。B型组患者术后及末次随访时冠状面平衡恢复优于C型组(t=-2.401、-2.659,均P<0.05)。两组患者末次随访时生活质量SF-36量表的生理功能总分、心理功能总分、ODI和VAS评分较术前均显著改善(均P<0.05)。结论伴B型和C型冠状面失衡的DS患者行后路截骨矫形术后可获得满意疗效,术后生活质量显著改善,伴B型冠状面失平衡的DS患者术后冠状面平衡改善更好。Objective To investigate the differences of the radiographic and clinical outcomes after posterior correction surgeries between degenerative scoliosis(DS)patients with type B and type C coronal pattern.Methods From March 2010 to August 2017,the clinical data of 38 patients(type B:24;type C:14)who were treated with posterior correction surgeries for DS were retrospectively reviewed.Radiographic parameters including Cobb angle of main curve,coronal imbalance(CI),lumbar lordosis(LL),global kyphosis(GK)and sagittal vertical axis(SVA)were measured on standing anteroposterior and lateral radiographs of the whole spine before and after surgery.Patient-reported outcomes were evaluated by using the visual analogue scale(VAS),the Oswestry disability index(ODI)and SF-36 questionnaire.The independent t-test was applied to compare the difference for statistical analysis.Results There was no significant differences between the two groups in terms of age,gender,follow-up duration,preoperative curve magnitude,severity of CI,sagittal malalignment and surgical strategies(all P>0.05).In patients with type B coronal pattern,the main curve was corrected from 44°±19°before surgery to 19°±7°immediately after surgery(t=8.496,P<0.001)and to 19°±6°at the last follow-up(t=-0.657,P=0.518).In patients with type C coronal pattern,the main curve was corrected from 43°±9°before surgery to 21°±4°immediately after surgery(t=13.537,P<0.001)and to 21°±5°at the last follow-up(t=-0.186,P=0.856).No significant difference of Cobb angle of main curve was found between the two groups either before the operation or immediately post operation(all P>0.05).In addition,significant improvement of CI was observed after surgery in both groups and the correction was maintained well at the last follow-up.However,patients with type C coronal pattern had greater CI than that in those with type B coronal pattern immediately post operation(t=-2.401,P=0.022)and at the last follow-up(t=-2.659,P=0.012).At the last follow-up the scores of SF-36 questionn

关 键 词：退变性脊柱侧凸 冠状面失衡 矫形效果 生活质量 

分 类 号：R687[医药卫生—骨科学]