退变性腰椎侧弯长短节段固定治疗的对比研究  

Comparative study of long and short segment fixation in the treatment of degenerative lumbar scoliosis

作　　者：潘建 蔡剑 徐房添[3] 赖仲宏 张亚梁 赖凌勇 缪圣旺 周波 PAN Jian;CAI Jian;XU Fang-tian;LAI Zhong-hong;ZHANG Ya-liang;LAI Ling-yong;MIAO Sheng-wang;ZHOU Bo(The First Clinical Medical School of Gannan Medical University;The First People's Hospital of Nankang District;Deapartment of Orthopedics,The First Affiliated Hospital of Gannan Medical University,Ganzhou,Jiangxi 341000)

机构地区：[1]赣南医学院第一临床医学院 [2]南康区第一人民医院 [3]赣南医学院第一附属医院骨科,江西赣州341000 [4]江西奉新人民医院骨科

出　　处：《赣南医学院学报》2023年第12期1230-1235,1244,共7页JOURNAL OF GANNAN MEDICAL UNIVERSITY

基　　金：赣州市科技局科技计划项目(GZ2018ZSF116)。

摘　　要：目的:探讨长节段与短节段固定治疗退变性腰椎侧弯畸形(Degenerative lumbar scoliosis,DLS)的术后疗效差异。方法:对2016年8月至2021年2月在赣南医学院第一附属医院骨科行长、短节段固定治疗的42例DLS患者资料进行回顾性分析。主要根据固定节段是否超越侧弯的上下端椎,分为长节段组(22例)和短节段组(20例),比较两组临床指标、术后末次随访和术前的临床与影像学资料。结果:两组患者术后随访时间25~73个月,平均39个月。短节段组手术时间、术中出血量及住院时间均明显少于长节段组(P<0.05)。两组末次随访视觉模拟评分(Visual annlogue scale,VAS)和Oswestry功能障碍指数评分(Oswestry disability index,ODI)较术前均有明显改善(P<0.05);两组腿部疼痛VAS评分及ODI评分的改善率比较差异无统计学意义(P=0.401、P=0.663),但腰背部疼痛VAS评分的改善率,长节段组明显好于短节段组(P<0.05)。长节段组末次随访时Cobb角、冠状面失平衡值(C7 plumb line-center sacral vertical line,C7-CSVL)、腰椎前凸角(Lumbar lordosis,LL)及矢状面失平衡值(C7 plumb line-sagittal vertical axis,C7-SVA)较术前明显改善(P<0.05),而短节段组改善有限(P>0.05)。Cobb角、C7-CSVL、LL、C7-SVA的术前与末次随访差值(改善程度),长节段组也明显优于短节段组,差异有统计学意义(P<0.05)。结论:短节段固定相较于长节段固定创伤更小,但不如长节段固定矫形能力强。建议长节段固定优先应用于身体状况良好且存在冠、矢状面失衡或以腰背疼痛为主要症状的患者;短节段固定则主要用于以神经卡压症状为主、冠矢状面平衡的患者。Objective:To explore the difference of postoperative efficacy between long-segment and short-segment fixation in treating degenerative lumbar scoliosis(DLS).Methods:A total of 42 patients with DLS who were surgically treated with long segment fixing or short segment fixing between August 2016 and February 2021 in the Orthopedic Department of The First Affiliated Hospital of Gannan Medical University;were selected for retrospective analysis.According to whether the fixed segment was beyond the upper and lower end vertebrae,they were divided into long segment group(22 cases)and short segment group(20 cases).The clinical data,the last follow-up data,and the clinical and imaging data before operation were compared between the two groups.Results:The patients were followed up for a average time of 39 months(25 to 73 months).The intraoperative blood loss,operation time,and hospitalization time of the short segment group were significantly less than those of the long segment group(P<0.05).In the evaluation of clinical efficacy,the last follow-up showed that the VAS and ODI scores of patients in the two groups were significantly improved compared with those before surgery(P<0.05).There were no significant differences in the improvements of VAS score of leg pain and ODI score between the two groups(P=0.401,P=0.663),but in the VAS score of back pain,the improvement of the long segment group was higher than that of the short segment group(P<0.05).The Cobb angle,C7-CSVL,LL and C7-SVA were significantly improved in the long segment group at last follow-up than those before operation(P<0.05),while there was no significant difference in the short segment group(P>0.05).The value before operation of Cobb angle,C7-CSVL,LL and C7-SVA minus those at last follow-up,the improvement were significantly better in the long segment group than those in the short segment group,with statistical significance(P<0.05).Conclusion:There was less surgical trauma with short segment fixation,but less effective in correcting deformity and relieving low

关 键 词：退变性腰椎侧弯畸形 长节段固定 短节段固定 

分 类 号：R682.3[医药卫生—骨科学]