长节段与短节段固定治疗退行性腰椎侧凸并椎管狭窄的短期临床疗效分析

Short term clinical analysis of long segment and short segment fixation for degenerative lumbar scoliosis associated with spinal stenosis

目的分析长节段与短节段固定治疗退行性腰椎侧凸(DLS)并椎管狭窄的短期临床疗效,探索手术适应证。方法回顾性分析第二军医大学附属长征医院脊柱外科2014年1月—2015年7月收治的81例DLS并椎管狭窄患者临床资料,其中长节段组(A组)33例,手术节段为T_(10)~S_1 10例、T_(10)~L_5 4例、T_(11)~S_1 12例、T_(11)~L_5 7例;短节段组(B组)48例,手术节段为L_(2~4) 2例、L_(3,4) 4例、L_(3~5) 10例、L_(4,5) 12例、L_4~S_1 12例,L_5~S_1 8例。记录并比较术前及末次随访时腰椎侧凸Cobb角、腰椎活动度(ROM)、腰痛视觉模拟量表(VAS)评分、下肢痛VAS评分、Oswestry功能障碍指数(ODI)及并发症发生情况。结果 A组末次随访时腰椎侧凸Cobb角、腰椎ROM显著小于B组,差异有统计学意义(P<0.05)。A组末次随访腰痛VAS评分及ODI显著低于B组,差异有统计学意义(P<0.05);下肢痛VAS评分2组比较差异无统计学意义(P>0.05)。A组围手术期出现脑脊液漏2例、切口感染2例、肺部感染1例、一过性神经根损伤1例,B组出现脑脊液漏1例、一过性神经根损伤1例。结论 2种固定方式均能有效改善DLS并椎管狭窄患者下肢疼痛及间歇性跛行症状。与短节段固定相比,长节段固定对腰痛改善效果较好,但腰椎ROM变小且围手术期并发症较多。

Objective To analyze the short-term clinical efficacy of long segment and short segment fixation for degenerative lumbar scoliosis(DLS)associated with spinal stenosis,and explore the surgical indications.Methods From January2014toJuly2015,81DLS patients with spinal stenosis treated in Changzheng Hospital were involved in this retrospective study.For long segment group(group A,33cases),operated segments were T10-S1in10patients,T10-L5in4,T11-S1in12,T11-L5in7;and short segment group(group A,348cases),operated segments were L2-4in2patients,L3,4in4,L3-5in10,L4,5in12,L4-S1in12,L5-S1in8.Scoliosis Cobb's angle,rang of motion(ROM),low back pain visual analogue scale(VAS)score,leg pain VAS score,Oswestry disability index(ODI)and complications had been used for comparing the difference between the2groups.Results Scoliosis Cobb's angle and ROM in group A were significantly less than those in group B at the final follow-up(P<0.05).Low back pain VAS score and ODI in group A were significantly lower than those in group B at the final follow-up(P<0.05).Leg pain VAS score showed no statistical significance between the2groups(P>0.05).Cerebrospinal fluid leak and wound infection were occurred in2patients respectively,lung infection and nerve root injury in1respectively in group A,but there was only1case of cerebrospinal fluid leak case and nerve root injury respectively in group B.Conclusion Both long and short segment fixation can effectively improve the leg pain and intermittent claudication symptoms.Compared with short segment fixation,long segment fixation is better in relieving lumbar pain,but poorer in maintaining lumbar spine mobility and provides more complications.