经后路长节段腰椎体间融合术治疗成人脊柱退行性侧凸疗效观察  

Effect and prognosis of posterior long segment lumbar interbody fusion in the treatment of adult degenerative scoliosis

作　　者：马维理 陈国奋 MA Wei-li;CHEN Guo-fen(Department of Spine and Joint,Hainan Zhongde Orthopaedic Hospital,Haikou 570203,Hainan,CHINA)

机构地区：[1]海南中德骨科医院脊柱关节科,海南海口570203

出　　处：《海南医学》2021年第10期1268-1271,共4页Hainan Medical Journal

摘　　要：目的探讨经后路长节段腰椎体间融合术治疗成人脊柱退行性侧凸的疗效。方法选择2016年3月至2018年11月海南中德骨科医院收治的90例成人脊柱退行性侧凸患者作为研究对象,按照随机数表法分为长节段组和短节段组,每组45例。长节段组采用经后路减压长节段腰椎体间融合术,短节段组采用经后路减压短节段椎体间融合术。比较两组患者的手术时间、术中出血量、术中涉及节段、住院时间,以及手术前、手术后1年时的腰部、下肢视觉模拟评分法(VAS)、侧凸、后凸Cobb角、Cobb角矫正率、Oswestry功能障碍指数(ODI)的变化和并发症发生率。结果长节段组患者的手术时间和住院时间分别为(250.51±27.24)min、(13.75±1.64)d,明显长于短节段组的(164.70±20.81)min、(9.51±1.55)d,术中出血量和术中涉及节段分别为(1975.52±215.18)mL、(6.13±1.58)个,明显多于短节段组的(1301.42±186.34)mL、(4.26±0.51)个,差异均有统计学意义(P<0.05);术后1年时,两组患者的腰部、下肢VAS评分、ODI评分比较差异均无统计学意义(P>0.05);术后1年时,长节段组患者的侧凸Cobb角和后凸Cobb角分别为(16.42±3.03)°、(17.32±2.65)°,明显低于短节段组的(22.15±2.51)°、(22.96±2.40)°,侧凸Cobb角矫正率和后凸Cobb角矫正率分别为(66.26±5.85)%、(56.21±4.11)%,明显高于短节段组的(54.24±5.27)%、(42.37±3.89)%,差异均有统计学意义(P<0.05);两组患者的并发症发生率均为2.22%,差异无统计学意义(P>0.05)。结论经后路长节段腰椎体间融合术可明显改善成人脊柱退行性侧凸患者脊柱畸形,预后良好,但手术时间和住院时间较长、术中出血量及涉及节段较多,对于身体机能较差的患者可选择短节段融合术减少创伤。Objective To study the effect and prognosis of posterior long segment lumbar interbody fusion in the treatment of adult degenerative scoliosis.Methods A total of 90 patients with adult degenerative scoliosis who received therapy from March 2016 to November 2018 in Hainan Zhongde Orthopaedic Hospital were selected as research objects.According to the random number table,they were divided into the long segment group and the short segment group,with 45 patients in each group.The long segment group was treated by posterior lumbar decompression and long segment lumbar interbody fusion,and the short segment group was treated by posterior decompression and short segment interbody fusion.The operation time,intraoperative hemorrhage,intraoperative segment involved and hospitalization time,the changes of the waist,lower limbs visual analogue scoring method(VAS),scoliosis,kyphosis Cobb angle,Cobb angle correction rate,Oswestry dysfunction index(ODI)before and one year after operation and complication rate were compared between the two groups.Results The operation time and hospitalization time in the long segment group were(250.51±27.24)min,(13.75±1.64)d,which were significantly longer than(164.70±20.81)min,(9.51±1.55)d in the short segment group,while the amount of bleeding and number of segments involved were(1975.52±215.18)mL,(6.13±1.58)number,which were significantly more than(1301.42±186.34)mL,(4.26±0.51)number in the short segment group(P<0.05).There was no significant difference in the waist and lower limbs VAS scores,ODI scores between the two groups at 1 year after operation(P>0.05).One year after operation,the scoliosis Cobb angle and kyphosis Cobb angle in long segment group were(16.42±3.03)°,(17.32±2.65)°,which were significantly lower than(22.15±2.51)°,(22.96±2.40)°in the short segment group,and the scoliosis Cobb angle correction rate and kyphosis Cobb angle correction rate in long segment group were(66.26±5.85)%,(56.21±4.11)%,which were significantly higher than(54.24±5.27)%,(42.37±3.89)%in

关 键 词：成人 脊柱退行性侧凸 腰椎体间融合术 长节段 短节段 疗效 

分 类 号：R681.5[医药卫生—骨科学]