腰椎后路短节段减压融合内固定治疗ADS并椎管狭窄的近远期疗效观察  

Short Segment Decompression Fusion and Internal Fixation in ADS with Spinal Stenosis via Posterior Lumbar Approach in the Short and Long-Term Efficacy

作　　者：练继平 Lian Ji-ping(Department of Surgery,Chongyi People's Hospital,Ganzhou 341300,Jiangxi,China)

机构地区：[1]江西省崇义县人民医院外科,江西赣州341300

出　　处：《四川生理科学杂志》2024年第11期2498-2501,共4页

摘　　要：目的:探究腰椎后路短节段减压融合内固定治疗成人退变性脊柱侧凸(Adult degenerative scoliosis,ADS)并椎管狭窄的近远期疗效观察。方法:将2022年1月至2024年1月我院收治的60例ADS并椎管狭窄患者纳入研究,随机分为联合组和内固定组(n=30),分别接受内固定术治疗和腰椎后路短节段减压融合内固定治疗。观察两组患者的围术期参数(手术时间、术中出血量、住院时间);术后7 d使用视觉模拟评分量表(Visual analogue scale,VAS)、腰痛评分标准(Japanese Orthopaedic Association score,JOA)测定患者的疼痛水平;使用Oswestry功能障碍指数(Oswestry disability index,ODI)测定患者的腰椎功能水平;使用影像学检查患者冠状面Cobb角、矢状面胸椎后凸(Thoracic kyphosis,TK)、腰椎前突(Lumbar lordosis,LL)变化;术后3 m使用肌张力测试仪测试患者腰部前屈、后伸的躯干肌力和活动度,记录患者术后并发症发生率和术后3 m的复发率。结果:联合组患者的手术时间长于内固定组,术后住院时间短于内固定组(P<0.05),两组患者的术中出血量无显著差异(P>0.05);联合组患者术后VAS、ODI评分低于内固定组,JOA评分高于内固定组(P<0.05);联合组术后脊柱Cobb角高于内固定组,两种患者的TK、LL角无显著差异(P>0.05);联合组患者术后3 m的腰椎躯干肌力、活动度均高于内固定组(P>0.05);联合组患者术后并发症发生率及术后3m复发率均低于内固定组(P<0.05)。结论:腰椎后路短节段减压融合内固定可有效缓解ADS并椎管狭窄患者的腰椎疼痛,改善腰椎功能,恢复腰椎活动能力并降低术后复发率。Objective:To explore the short-term and long-term efficacy of posterior lumbar short-segment decompression and fusion with internal fixation for treating adult degenerative scoliosis(ADS)with spinal stenosis.Method:Sixty patients with ADS and spinal stenosis admitted to our hospital from January 2022 to January 2024 were included in the study and randomly divided into a combined group and an internal fixation group(n=30),who received internal fixation surgery and posterior lumbar short-segment decompression fusion with internal fixation,respectively.The perioperative parameters(operation time,intraoperative blood loss,length of hospital stay)of the two groups of patients were observed.The pain level of patients was measured using the Visual analogue scale(VAS)and the Japanese Orthopaedic Association score(JOA)7 days after surgery.The Oswestry disability index(ODI)was used to assess the level of lumbar function in patients.Imaging was used to examine the changes in the patient's coronal Cobb angle,sagittal thoracic kyphosis(TK),and lumbar lordosis(LL).After 3 months of surgery,the trunk muscle strength and mobility of the patient's lumbar flexion and extension were tested using a muscle tension tester,and the incidence of postoperative complications and recurrence rate at 3 months were recorded.Results:The operation time of the combined group was longer than that of the internal fixation group,and the postoperative hospitalization time was shorter than that of the internal fixation group(P<0.05).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).The VAS and ODI scores of the combined group were lower than those of the internal fixation group,while the JOA score was higher(P<0.05).The Cobb angle of the spine in the combined group was higher than that in the internal fixation group,but there was no significant difference in the TK and LL angles between the two groups(P>0.05).The lumbar trunk muscle strength and range of motion in the combined group were higher than those

关 键 词：成人退变性脊柱侧凸 椎管狭窄 腰椎后路短节段减压术 内固定术 

分 类 号：R68[医药卫生—骨科学]