两种内固定方案治疗胸腰段先天性脊柱侧凸临床对比分析

Clinical comparative analysis of two kinds of internal fixation schemes in the treatment of thoracolumbar congenital scoliosis

目的探讨相邻单节段和相邻双节段内固定方案对胸腰段先天性脊柱侧凸患者手术相关临床指标、Cobb角改善效果及并发症的影响。方法研究对象选取我院2016年12月-2018年12月收治胸腰段先天性脊柱侧凸患者共80例,以随机数字表法分为相邻单节段组(40例)和相邻双节段组(40例),分别采用相邻单节段和相邻双节段内固定方案治疗;比较两组患者手术操作用时,手术出血量,手术前后侧凸/后凸Cobb角改善效果及术后并发症发生率。结果相邻双节段组患者手术操作用时和手术出血量均显著多于相邻单节段组(P<0.05);相邻双节段组患者术后侧凸/后凸Cobb角度数、Cobb角矫正率及Cobb角矫正丢失度均显著优于相邻单节段组(P<0.05);同时两组患者术后并发症发生率比较差异无显著性(P>0.05)。结论与相邻单节段内固定方案相比,相邻双节段内固定方案治疗胸腰段先天性脊柱侧凸可有效纠正脊柱畸形,避免矫正丢失,并有助于降低并发症发生风险,但可能增加操作用时和医源性创伤。

Objective To investigate the influence of adjacent single segment and adjacent two segment internal fixation on surgical related clinical indicators,Cobb angle improvement and complications in patients with thoracolumbar congenital scoliosis.Methods 80 patients with ithoracolumbar congenital scoliosis were chosen by posterior internal fixation fusion in the period from December 2016 to December 2018 in our hospital.All patients were randomly divided into adjacent single segment group(40 cases)and adjacent double segment group(40 cases)by random number table method,and were treated with adjacent single segment and adjacent double segment internal fixation scheme respectively;the operation bleeding volume,the improvement effect of scoliosis/kyphosis Cobb angle before and after operation and the incidence of postoperative complications of 2 groups were compared.Results The operation time and blood loss in the two adjacent segments group were significantly higher than those in the adjacent single segment group(P<0.05).The scoliosis/kyphosis Cobb angle degree,Cobb angle correction rate and Cobb angle correction loss degree of adjacent two segment group were significantly better than those of adjacent single segment group(P<0.05).There was no significant difference in the incidence of postoperative complications between 2 groups(P>0.05).Conclusion Compared with adjacent single segment internal fixation,adjacent two segment internal fixation can effectively correct spinal deformity,avoid correction loss,and reduce the risk of complications,but it may increase the operation time and iatrogenic trauma.