成人退变性脊柱侧凸患者行减压后长节段固定与短节段固定融合术的疗效比较

Comparison of the curative effect of long-segment and short-segment fixation and fusion after decompression in adult patients with degenerative scoliosis

目的比较分析成人退变性脊柱侧凸(DS)患者行减压后长节段或短节段固定融合术的疗效。方法根据不同融合节段将行后路减压椎弓根螺钉固定融合术的89例DS患者分为长节段组与短节段组,比较两组手术指标、并发症、手术前后疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、侧凸Cobb角变化。结果长节段组手术时间、术中出血量、融合节段、住院时间均显著长于短节段组(P<0.05);长节段组末次随访时VAS评分(2.13±0.64)分,显著高于短节段组的(1.12±0.57)分(P<0.05),ODI评分(8.07±1.04)分,显著低于短节段组的(14.26±1.68)分(P<0.05);长节段组末次随访时侧凸Cobb角及其矫正率均显著优于短节段组(P<0.05)。结论长节段、短节段融合治疗DS各有优劣,前者在改善侧凸Cobb角及脊柱功能上有明显优势,后者创伤更小,并发症更少,安全性较高。

Objective To compare the curative effect of long-segment or short-segment fixation and fusion after decompression in adult patients with degenerative scoliosis（DS）. Methods According to different fusion segments, 89 patients with DS treated by posterior decompression and pedicle screw fixation and fusion were divided into the long-segment group and the short-segment group. The operation indicators, complications, scores of visual analogue scale（VAS） before and after operation,Oswestry dysfunction index（ODI） and changes in Cobb angle of scoliosis were compared between the two groups. Results The operation time, intraoperative blood loss, fusion segment and length of hospital stay of the long-segment group were significantly longer or more than those of the short-segment group（P 0.05）. VAS score of the long-segment group at the end of the follow-up was significantly higher than that of the short-segment group [（2.13±0.64） vs（1.12±0.57）], while the ODI score was significantly lower than that of the short-segment group [（8.07±1.04） vs（14.26±1.68）]（P〈 0.05）. The Cobb angle of scoliosis and its correction rate in the long-segment group at the end of the follow-up were significantly larger or higher than those in the short-segment group（P〈 0.05）.Conclusion Long-segment and short-segment fusion have their own advantages and disadvantages in the treatment of DS. The former has obvious advantages in improving the Cobb angle of scoliosis and spinal function,while the trauma of the latter is smaller, complications are fewer and safety is higher.