责任节段减压联合矫形固定短节段融合手术治疗退变性腰椎侧弯的效果评价  

Effect Evaluation of Responsible Segmental Decompression Combined with Orthopedic Fixation of Short-Segment Fusion Surgery for Treating Degenerative Lumbar Scoliosis

作　　者：曾辉 吴刚强[1] 黄灿 韩晓军 刘波[1] 陈诚[1] 马龙 张博文 王宏海 ZENG Hui;WU Gangqiang;HUANG Can;HAN Xiaojun;LIU Bo;CHEN Cheng;MA Long;ZHANG Bowen;WANG Honghai(Department of Orthopedics,the Second People′s Hospital of Fuyang City,Fuyang 236015,Anhui,China;School of Basic Medical Sciences,Anhui Medical University,Hefei 230032,China)

机构地区：[1]阜阳市第二人民医院骨科,安徽阜阳236015 [2]安徽医科大学基础医学院,合肥230032

出　　处：《医用生物力学》2024年第5期896-902,共7页Journal of Medical Biomechanics

基　　金：安徽省自然科学基金项目(2108085QH338)。

摘　　要：目的探讨责任节段减压联合矫形固定短节段融合手术在退变性腰椎侧弯中的疗效。方法退变性腰椎侧弯患者124例,采用随机数字表法分为短节段和长节段融合组,每组62例。短节段融合组经后路短节段减压固定融合,融合节段为相邻腰椎;长节段融合组经后路长节段减压固定融合,融合节段为相邻多个腰椎。术后6个月,比较两组冠状面腰椎侧凸Cobb角、矢状面腰椎前凸Cobb角、椎间孔高度、椎间隙高度、椎间孔面积、椎管面积、椎管直径、日本矫形外科协会(JOA)评分、Oswestry功能障碍指数(ODI)、腰背部及下肢的疼痛程度及术后并发症。结果术后6个月,短节段融合组和长节段融合组患者的冠状面腰椎侧凸Cobb角较术前均减小,矢状面腰椎前凸Cobb角较术前均增大(P<0.05)。术后6个月,短节段和长节段融合组患者的椎间孔高度、椎间隙高度、椎间孔面积、椎管面积及椎管直径均增加,短节段融合组高于长节段融合组(P<0.05)。术后6个月,短节段和长节段融合组患者JOA评分较术前均升高,短节段融合组高于长节段融合组(P<0.05);短节段和长节段融合组患者ODI评分较术前均降低,短节段融合组低于长节段融合组(P<0.05)。术后6个月,短节段和长节段融合组患者腰背部及下肢的疼痛程度评分较术前均降低(P<0.05)。长节段融合组术中椎板硬脊膜黏连所致减压过程中硬脊膜撕裂2例,短节段融合组未监测到严重并发症。结论经后路短节段减压固定融合与长节段减压固定融合在退变性腰椎侧弯的治疗上均可取得良好的疗效,而短节段融合组经后路短节段减压固定融合术的手术时间较短,术中出血量较低,腰椎功能恢复状态更优,且术后并发症的发生风险更低。Objective To investigate the therapeutic effect of segmental decompression combined with corrective short-segment fusion surgery for the treatment of degenerative lumbar scoliosis.Methods In total,124 patientswith degenerative lumbar scoliosis were selected and divided into short-and long-segment fusion groups usingthe random number table method,with 62 patients in each group.Posterior short-segment decompression,fixation,and fusion were performed in the short-segment fusion group;the fusion segment was the adjacentlumbar vertebra.Posterior long-segment decompression,fixation,and fusion were performed in the longsegmentfusion group;the fusion segments included multiple adjacent lumbar vertebrae.At the 6th month aftersurgery,the coronal Cobb angle of lumbar convexity,sagittal Cobb angle of lumbar lordosis,intervertebralforamen height,intervertebral space height,intervertebral foramen area,spinal canal area,spinal canaldiameter,Japanese Orthopedic Association(JOA)score,Oswestry Disability Index(ODI),degree of pain inthe lower back and lower limbs,and postoperative complications were compared between the groups.Results The Cobb angle of the coronal lumbar scoliosis in the short-and long-segment fusion groups was significantlyhigher than that before surgery(P<0.05).At the 6th month after surgery,the intervertebral foramen height,intervertebral space height,intervertebral foramen area,spinal canal area,and spinal canal diameter in bothgroups increased,and those in the short-segment fusion group were higher than those in the long-segment fusiongroup(P<0.05);at the 6th month after the operation,the JOA scores of the short-segment and long-segmentfusion groups were higher than those before surgery,and the JOA score of the short-segment fusion group washigher than that of the long-segment fusion group(P<0.05).The ODI score was lower than that before surgeryin the short-and long-segment fusion groups,and the ODI score in the short-segment fusion group was lowerthan that in the long-segment fusion group(P<0.05).At the 6th m

关 键 词：退变性腰椎侧弯 节段减压 短节段融合 长节段融合 

分 类 号：R318.01[医药卫生—生物医学工程]