长节段与短节段椎弓钉固定退行性脊柱侧弯的比较

Long-segment versus short-segment pedicle screw fixation for degenerative scoliosis in the elderly

[目的]比较长节段与短节段椎弓钉固定老年退行性脊柱侧弯(degenerative scoliosis,DS)的近期临床效果。[方法]回顾性分析本院2017年6月-2019年12月手术治疗120例DS患者。依据术前医患沟通结果,62例接受长节段融合(长节段组),58例接受短节段融合方式(短节段组)。比较两组围手术期、随访和影像资料。[结果]两组手术均顺利完成,术中均未发生血管、神经损伤等严重并发症。短节段组手术时间、切口长度、术中透视次数、固定节段数、术中出血量、术后引流量和住院时间均显著优于长节段组(P<0.05)。所有患者均随访12个月以上。与术前相比,末次随访时两组患者VAS评分和ODI评分均显著减少(P<0.05)。末次随访时,长节段组的VAS评分[(1.42±0.86)vs(3.65±1.48),P<0.05]和ODI评分[(28.29±4.74)%vs(39.63±4.49)%,P<0.05]均显著低于短节段组。影像方面,与术前相比,末次随访时两组患者侧弯Cobb角、C7 PL和SVA均显著减少(P<0.05)。末次随访时,长节段组的侧弯Cobb角[(18.13±3.82)°vs(27.53±4.78)°,P<0.05]、C7 PL[(13.47±2.63)mm vs(19.45±3.84)mm,P<0.05]和SVA[(17.73±2.86)mm vs(29.76±3.85)mm,P<0.05]均显著小于短节段组。[结论]短节段减压固定治疗具有手术创伤小的优势,而长节段减压固定治疗可有效恢复脊柱的力线及功能。建议依据DS患者的年龄、耐受度、神经压迫等因素选择固定范围。

[Objective]To compare the short-term clinical outcomes of long-segment versus short-segment pedicle screw fixation for degenerative scoliosis(DS)in the elderly.[Methods]A retrospective study was conducted on 120 patients who underwent surgical treatment for DS in our hospital from June 2017 to December 2019.Based on the consequence of doctor-patient communication,62 patients received long-segment instrumented fusion,while the remaining 58 patients received short-segment instrumented fusion.The patients in the two groups were compared regarding to the documents of perioperative period,follow-up and images.[Results]All patients in both groups had operation completed successfully with no serious complications,such as injuries to blood vessels and nerves.The short-segment group was significantly superior to the long-segment group in terms of operation time,incision length,intraoperative fluoroscopy,number of fixed segments,intraoperative blood loss,postoperative drainage and hospital stay(P<0.05).All patients were followed up for more than 12 months.The VAS score and ODI score significantly reduced at the latest follow-up in both groups compared with those before operation(P<0.05).At the latest follow-up,the long-segment group proved significantly superior to the short-segment group regarding to VAS score[(1.42±0.86)vs(3.65±1.48),P<0.05]and ODI score[(28.29±4.74)%vs(39.63±4.49)%,P<0.05].With respect of radiographic assessment,the scoliotic Cobb angle,C7 PL and SVA significantly decreased at the latest follow-up compared with those preoperatively in both groups(P<0.05).At the latest follow-up,the long-segment group was significantly better than the short-segment group in term of scoliotic Cobb angle[(18.13±3.82)°vs(27.53±4.78)°,P<0.05],C7 PL[(13.47±2.63)mm vs(19.45±3.84)mm,P<0.05]and SVA[(17.73±2.86)mm vs(29.76±3.85)mm,P<0.05].[Conclusion]Short-segment instrumented fusion takes the advantage of less surgical trauma,while the longsegment counterpart does restore the spinal alignment and function more effectively.It is recommended to choose a proper fixed range based on factors,such as age,tolerance,and extent of nerve compression for DS in the elderly.