后路长节段固定治疗成人退行性脊柱畸形的疗效及其远端并发症

Long segment fusion for adult degenerative spinal deformity: outcomes and distal segment complications

目的：探讨后路长节段固定治疗成人退行性脊柱畸形的效果以及远端并发症的发生率。方法：回顾性分析2010年1月~2015年1月在我院接受一期后路长节段椎弓根螺钉固定矫形治疗的成人脊柱畸形患者，病例入选标准：（1）诊断为成人退行性脊柱畸形；（2）年龄超过50岁；（3）影像学满足冠状面Cobb角度〉20°，或者矢状面平衡（SVA）〉5cm；（4）后方腰椎固定融合在4个节段以上；（5）随访时间在12个月以上。分析患者的人口学特点、影像学参数、健康相关生活质量评分和远端并发症等资料。结果：共纳入74例患者，其中远端固定椎在L5的患者43例（L5组），固定在S1的患者22例（S1组），固定到髂骨的患者9例（髂骨组）。随访12~64个月，平均28.8个月，三组患者术后冠状面Cobb角、冠状面平衡（CSVL）、矢状面平衡（SVA）、PI-LL、PT角度与术前比较均有显著性改善（P〈0.05）。术后健康相关生活质量评分（ODI和SF-12 PCS）与术前相比均得到明显改善（P〈0.05）。远端并发症总的发生率为29.7%（22/74），保留L5/S1椎间盘患者远端并发症的发生率显著性高于L5/S1融合的患者（39.5% vs 16.1%），保留L5/S1椎间盘是远端并发症的独立危险因素（P=0.03）。结论：长节段固定融合治疗成人退行性脊柱畸形能够改善患者的健康相关生活质量评分，获得满意的临床效果；保留L5/S1椎间盘发生远端并发症的风险更高。

Objectives： To investigate the outcomes of long instrumentation in adult degenerative spinal deformity, and to explore the rate of distal segment complications. Methods： Adult spinal deformity patients who underwent posterior surgery in our institution between January 2010 and January 2015 were retrospectively reviewed. Inclusion criteria were age more than fifty, either coronal Cobb angle 〉20° or sagittal balance（SVA） 〉5cm, more than 4 lumbar segments fixation, at least 12 months follow-up. Demographic data, Oswestry disable index（ODI）, SF-12 PCS scores, radiographic parameters and distal segment complications were analyzed. Results： Seventy-four patients were evaluated in this study, 43 cases stopped at L5, 22 cases at sacrum and 9 cases at ilium. The average follow-up time was 28.8 months（range, 12-64 months）. Radiographic parameters including Cobb angle, CSVL, SVA, PI-LL, PT improved significantly at last follow-up in each group; ODI and SF-PCS scores changed significantly as well. Distal segment complication rate was 29.7%（22/74） totally. There was significant difference in distal segmental complication rate between patients who saved L5/S1 and fused L5/S1（39.6% vs. 16.1%）. Saving L5/S1 disc was an independent risk factor of distal segment complication（P=0.03）. Conclusions： Posterior long segment instrumentation and fusion for adult degenerative spinal deformity can improve the patient′s health related quality of life score and obtain satisfying clinic outcome. Saving L5/S1 disc may lead to high risk of distal segmental complication.