长节段与短节段融合联合后路椎弓根螺钉系统内固定术在退变性脊柱侧弯治疗中的对比分析

Comparative Analysis of Long and Short Level Fusion Combined with Posterior Pedicle Screw System in the Treatment of Degenerative Scoliosis

目的探讨长节段与短节段融合联合后路椎弓根螺钉系统内固定术在退变性脊柱侧弯中的应用价值.方法选取2021年6月—2023年6月我院收治的60例退变性脊柱侧弯患者为研究对象,按随机数字表法将其分为对照组与观察组,各30例.两组均行后路椎弓根螺钉系统内固定术,对照组行短节段融合,观察组行长节段融合.随访3个月,比较两组手术情况、影像学参数、疼痛评分、Oswsetry功能障碍指数(ODI)评分、生活质量.结果观察组手术时间为(232.41±28.68)min,长于对照组的(164.85±14.83)min,术中出血量、术后引流量、术中透视次数分别为(554.96±52.41)mL、(156.32±14.82)mL、(6.32±1.15)次,均多于对照组的(449.65±45.84)mL、(123.41±13.35)mL、(4.21±0.83)次,组间差异有统计学意义(P<0.05);观察组术后侧凸Cobb角、矢状面平衡偏移量、冠状位平衡偏移量分别为(18.15±1.63)°、(17.79±1.45)mm、(13.51±1.23)mm,均低于对照组的(22.34±2.49)°、(23.53±2.57)mm、(16.78±1.45)mm,组间差异有统计学意义(P<0.05);观察组术后疼痛视觉模拟评分、ODI评分分别为(1.42±0.24)分、(12.58±1.23)分,均低于对照组的(1.98±0.27)分、(15.39±1.42)分,组间差异有统计学意义(P<0.05);观察组术后生活质量各领域评分分别为(87.25±5.24)分、(88.26±5.19)分、(88.93±5.25)分、(90.76±4.15)分,均高于对照组的(80.62±5.21)分、(81.11±5.09)分、(82.04±5.18)分、(83.63±4.58)分,组间差异有统计学意义(P<0.05).结论长节段与短节段融合在退变性脊柱侧弯中各有价值,短节段融合手术创伤更小,长节段能更好恢复脊椎力线及功能,还需根据临床病情特点慎重选择.

Objective To investigate the application value of long-segment fusion and short-segment fusion combined with posterior pedicle screw system internal fixation in the treatment of degenerative scoliosis.Methods 60 patients with degenerative scoliosis admitted to our hospital from June 2021 to June 2023 were selected as the research objects.According to the random number table method,they were divided into a control group and an observation group,with 30 cases in each group.Both groups were treated with posterior pedicle screw system internal fixation.The control group was treated with short segment fusion,and the observation group with long segment fusion.After 3 months of follow-up,the operation,imaging parameters,pain score,Oswsetry Disability Index(ODI)score,and quality of life were compared between the two groups.Results The operation time of the observation group was(232.41±28.68)min,which was longer than(164.85±14.83)min of the control group.The intraoperative blood loss,postoperative drainage,and intraoperative fluoroscopy times were(554.96±52.41)mL,(156.32±14.82)mL,and(6.32±1.15)times,respectively.Compared with the control group(449.65±45.84)mL,(123.41±13.35)mL and(4.21±0.83)times,the differences between the two groups were statistically significant(P<0.05).The postoperative Cobb Angle,Sagittal balance offset and coronal balance offsct of the observation group were(18.15±1.63)°,(17.79±1.45)mm and(13.51±1.23)mm,respectively,which were lower than(22.34±2.49)°,(23.53±2.57)mm and(16.78±1.45)mm of the control group.The difference between the two groups was statistically significant(P<0.05).The postoperative Visual Analog Scale of Pain score and ODI score of the observation group were(1.42±0.24)points and(12.58±1.23)points,respectively,which were lower than(1.98±0.27)points and(15.39±1.42)points of the control group,the differences between the two groups were statistically significant(P<0.05).The scores of quality of life in the observation group were(87.25±5.24)points,(88.26±5.19)points,(88.93±5.25)points and(90.76±4.15)points,respectively.The scores were higher than(80.62±5.21)points,(81.11±5.09)points,(82.04±5.18)points,(83.63±4.58)points of the control group,the differences between the two groups were statistically significant(P<0.05).Conclusion Both long-segment and short-segment fusion are valuable in the treatment of degenerative scoliosis.Short-segment fusion is less invasive,while long-segment fusion can better restore spinal alignment and function,which should be carefully selected according to the clinical characteristics.