长节段固定融合术治疗成人退行性脊柱侧弯的效果观察

Effects of Long-segment Fixation and Fusion in the Treatment of Adult Degenerative Scoliosis

目的探究长节段固定融合术治疗成人退行性脊柱侧弯的效果。方法回顾性分析2013年7月至2018年2月我院收治的49例退行性脊柱侧弯患者的临床资料,所有患者均行长节段固定融合术,术后接受随访。收集患者手术情况,比较术前及随访时影像学资料、疼痛评分及功能障碍评分变化差异。结果49例患者末次随访时腰椎前凸角、冠状面Cobb角、顶椎偏移距离分别为(33.52±8.85)°、(11.24±3.52)°及(15.96±6.95)mm,明显优于术前(P<0.05);随访时患者VAS评分为(2.95±1.01)分,显著优于术前的(7.84±1.66)分(P<0.05);术前患者ODI评分为(13.46±2.88)分,随访时为(68.93±7.24)分,术前及随访时比较差异显著(P<0.05),治疗总体疗效评价优良率为89.79%;术后共12例(24.49%)患者出现并发症,其中近期并发症8例,包括硬膜外血肿、脑脊液漏、感染;4例(8.16%)患者出现远期并发症,包括相邻节段退变、螺钉松动。结论长节段固定融合术治疗退行性脊柱侧弯具有较好疗效,安全性尚可。

Objective To explore the effects of long-segment fixation and fusion in the treatment of adult degenerative scoliosis.Methods The clinical data of 49 patients with degenerative scoliosis admitted to our hospital from July 2013 to February 2018 were retrospectively analyzed.All patients underwent long-segment fixation and and fusion and were followed up after surgery.The operation was collected and the imaging data,pain score and dysfunction score were compared before operation and at follow-up.Results In the last follow-up of 49 patients,the lumbar lordosis angle,coronal Cobb angle and apical vertebrae offset distance were(33.52±8.85)°,(11.24±3.52)°and(15.96±6.95)mm respectively,which were significantly better than those before operation(P<0.05).At follow-up,the VAS score was significantly better than that before operation[(2.95±1.01)points vs(7.84±1.66)points](P<0.05).The ODI score was(13.46±2.88)points before operation and(68.93±7.24)points at follow-up,and there was a significant difference between before operation and at follow-up(P<0.05).The excellent and good rate of treatment overall efficacy was 89.79%.A total of 12 patients(24.49%)had complications after operation,including 8 cases of recent complications(including epidural hematoma,cerebrospinal fluid leakage,infection).4 cases(8.16%)patients had long-term complications,including adjacent segment degeneration and screw loosening.Conclusion Long-segment fixation and fusion for degenerative scoliosis has good efficacy and fair safety.