退行性脊柱侧弯椎管狭窄的减压融合与单纯减压比较

Decompression combined with instrumented fusion versus simple decompression for degenerative scoliosis accompanied with spinal canal stenosis

[目的]分析并比较单纯减压与减压融合治疗退行性脊柱侧弯合并椎管狭窄的疗效。[方法] 2017年3月~2019年3月,100例退行性脊柱侧弯合并椎管狭窄患者纳入本研究,按照随机数字表法分为两组。其中,50例采用减压融合术,50例采用单纯减压术。比较两组患者围手术期、随访和影像学资料。[结果]两组患者均顺利手术。减压融合组手术时间、切口长度、术中失血量、术中透视次数、术后引流量和住院时间均显著大于单纯减压组(P<0.05)。随时间推移,两组患者VAS评分和ODI评分显著减少(P<0.05),而JOA评分显著增加(P<0.05)。末次随访时,减压融合组VAS评分[(1.21±0.23) vs(3.65±0.51),P<0.05]、ODI评分[(10.08±2.11) vs (15.11±2.18),P<0.05]和JOA评分[(26.45±2.15) vs (19.44±2.41),P<0.05]均显著优于单纯减压组。影像方面,与术前相比,末次随访时两组患者Cobb角均显著减少(P<0.05)。术前两组患者间侧弯Cobb角的差异无统计学意义[(17.14±2.18%) vs (17.23±2.13)°,P>0.05],末次随访时,减压融合组的Cobb角显著小于单纯减压组[(6.56±1.37)°vs (14.48±2.04)°,P<0.05]。[结论]对于退行性脊柱侧弯合并椎管狭窄,减压融合术虽较单纯减压术医源性创伤大,但可有效矫正畸形,取得更好的临床效果。

[Objective] To compare the clinical outcomes of decompression combined with instrumented fusion(DIF) versus simple decompression(SD) for the treatment of degenerative scoliosis accompanied with spinal stenosis. [Methods] From March 2017 to March 2019, a total of 100 patients with degenerative scoliosis accompanied with spinal stenosis were enrolled in this study, and were divided into two groups by random number table. Among them, 50 patients received DIF, while the remaining 50 patients had SD performed. The patients in the two groups were compared regarding to the perioperative, follow-up and imaging data. [Results] The patients in both groups were successfully operated on. The DIF group consumed significantly longer operation time, associated with significantly greater incision length, intraoperative blood loss, frequency of intraoperative fluoroscopy, postoperative drainage and hospital stay than the SD group(P<0.05). The VAS and ODI scores decreased significantly(P<0.05), while the JOA score increased significantly in the two groups over time(P<0.05). At the latest follow-up, the DIF group proved significantly superior to the SD group in the VAS score [(1.21±0.23) versus(3.65±0.51), P<0.05], ODI score [(10.08±2.11) versus(15.11±2.18), P<0.05], and JOA score [(26.45±2.15) versus(19.44±2.41), P<0.05].With regard to imaging evaluation, the Cobb angle in both groups significantly reduced at the latest follow-up compared with those preoperatively(P<0.05). Although there was no significant difference in the scoliotic Cobb angle between the two groups before surgery [(17.14±2.18%) versus(17.23±2.13)°, P>0.05], the DIF group had significantly less Cobb angle than the SD group at the last follow-up [(6.56±1.37)° versus(14.48±2.04)°, P<0.05]. [Conclusion] Although DIF is more traumatic than SD, the former does correct the deformity more effectively, and achieve better clinical results than the latter for degenerative scoliosis accompanied with spinal stenosis.