重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后

Effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis

目的探讨重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后。方法选择60例重度特发性胸腰段脊柱侧凸患者,随机分为2组。前后路组患者给予前后路联合内固定术,后路组患者给予后路联合内固定术。观察2组患者治疗情况、术前术后指标变化及随访情况。结果 2组患者手术时间、出血量、住院时间比较有显著差异(P<0.05);2组患者融合节段无显著差异(P>0.05)。2组术后主弯Cobb角、后凸角及躯干偏移均有显著改善(P<0.05)。2组末次随访主弯Cobb角丢失度数、后凸丢失度数、主弯Cobb角矫正率、后凸矫正率无显著差异(P>0.05)。结论前后路联合内固定术与后路联合内固定术对重度特发性胸腰段脊柱侧凸患者治疗效果相当,后路联合内固定术手术时间与住院时间更短,但出血量更大,风险更高。

Objective To investigate the effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis. Methods A total of 60 patients with severe idiopathic thoracolumbar scoliosis were randomly divided into two groups. The anterior and posterior group was treated with anterior and posterior internal fixa- tion, and posterior group was treated with posterior combined with internal fixation. Effect, preopera- tive and postoperative indicators and condition during follow - up were observed. Results There were significant differences in operation time, blood loss, length of stay between two groups （ P 〈 0.05 ）. There was no significant difference of fusion segments between two groups （ P 〉 0.05 ）. There were sig- nificant differences in the main bending angle Cobb, kyphosis and trunk shift between two groups （ P 〈 0.05 ）. There were no significant differences in the final follow-up Cobb angle loss, the degree of kyphosis loss, the correction rate of Cobb angle and the correction rate of kyphosis between two groups （P 〉 0.05 ）. Conclusion Anterior combined with posterior internal fixation is similar to posterior in- ternal fixation in treatment of patients with severe idiopathic thoracolumbar scoliosis, but the operation time and hospital stay are shorter by posterior internal fixation, and the amount of bleeding is greater and the risk is higher.