退变性腰椎侧弯合并椎管狭窄经选择性短节段减压植骨融合内固定术治疗的效果及邻近节段退变发生情况

Effect of selective segmental decompression and internal fixation on DLS complicated with spinal stenosis and the incidence of adjacent segment degeneration

目的分析选择性短节段减压植骨融合内固定术治疗退变性腰椎侧弯(DLS)合并椎管狭窄的效果及邻近节段退变发生情况。方法选取收治的76例DLS合并椎管狭窄患者进行研究,将患者按随机数字表法分为对照组和观察组,每组各38例。对照组给予单纯减压术进行治疗;观察组则采用选择性短节段减压植骨融合内固定术进行治疗。比较两组的优良率、腰椎生理前凸角及VAS评分,比较观察组患者术前术后椎间隙融合情况。结果观察组优良率(84.21%)明显高于对照组(52.63%),观察组邻近节段退变发生率(44.74%)明显高于对照组(13.16%),均差异有统计学意义(P<0.05);观察组术后的Cobb角(10.49±1.59)°及腰椎生理前凸角(35.69±3.19)°与术前的Cobb角(27.61±2.29)°及腰椎生理前凸角(11.71±2.21)°相比有明显改善,差异有统计学意义(P<0.05);术后末次随访时观察组VAS评分(1.23±0.49)分及JOA评分(26.79±3.77)分与对照组VAS评分(2.14±0.56)分及JOA评分(20.13±2.54)分相比,差异有统计学意义(P<0.05)。结论DLS合并椎管狭窄经选择性短节段减压植骨融合内固定术治疗后临床效果较好,有利于患者冠状Cobb角及腰椎生理前凸角的恢复,椎间隙融合情况良好,腰腿疼痛症状也得以有效缓解,但由于内固定降低了脊柱的灵活度及顺应性,邻近节段的退变较重。

Objective To analyze the effect of selective short segment decompression and internal fixation for the treatment of degenerative lumbar scoliosis( DLS) complicated with spinal stenosis and adjacent segment degeneration. Methods Seventy-six cases of DLS patients with spinal stenosis treated in Dongguan Hospital of TCM were selected and assigned into control group and observation group,38 cases in each group. The control group was treated with decompression,while the observation group was treated with selective segmental decompression and bone graft fusion and internal fixation. The excellent rate,lumbar lordosis angle and visual analogue scale( VAS) score of the patients in two groups were compared and the fusion of intervertebral space before and after operation was compared in the observation group. Results The excellent rate of the observation group( 84. 21%) was significantly higher than that of the control group( 52. 63%),and the rate of patients with adjacent segment degeneration( 44. 74%) was significantly higher than that of the control group( 13. 16%); the differences were statistically significant( P < 0. 05). In the observation group postoperative Cobb angle( 10. 49 ± 1. 59) ° and lumbar lordosis angle( 35. 69 ± 3. 19) °of the patients were improved remarkably compared with preoperative Cobb angle( 27. 61 ± 2. 29) ° and lumbar lordosis angle( 11. 71 ± 2. 21) °; the differences were statistically significant( P < 0. 05).During the final postoperative follow-up the VAS score( 1. 23 ± 0. 49) and JOA score( 26. 79 ± 3. 77) in the observation group were higher than those in the control group[( 2. 14 ± 0. 56) and( 20. 13 ± 2. 54) respectively]; the differences were statistically significant( P < 0. 05). Conclusions The effect of selective short segment decompression and internal fixation for the treatment of DLS complicated with spinal stenosis is relatively better,which is beneficial for the adjustment of coronary Cobb angle and lumbar lordosis angle,promotes intervertebral fusion,and alleviates lumbocrural pain,but because the internal fixation reduces the flexibility and adaptability of the spine,there is serious degeneration of adjacent segments.