退变性脊柱侧凸长节段固定融合不同远端固定椎并发症比较分析

An analysis of complications following different distal instrumented vertebra after posterior long segment fixation and fusion for degenerative lumbar scoliosis

目的研究选择不同的远端固定椎(distal instrumented vertebra,DIV)对退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)长节段后路融合并发症的影响。方法对2011年1月至2015年12月,于我院行后路长节段固定融合治疗的74例DLS患者进行回顾性研究,根据DIV止于L5还是S1分组比较分析其并发症。其中,A组(选择L5作为DIV) 44例,男11例,女33例,平均年龄(63.23±6.89)岁;B组(选择S1作为DIV) 30例,男8例,女22例,平均年龄(64.28±7.81)岁。分别对两组患者的术前年龄、性别、手术时间、术中出血量、术中减压节段和融合节段数和影像学指标[包括:侧凸冠状面Cobb’s角,腰椎前凸角,冠状面和矢状面平衡及早期并发症(3个月内)、晚期并发症(≥3个月)发生情况]比较分析。结果两组间年龄、性别、手术时间、术中出血量、内固定节段数和减压节段数差异无统计学意义(P>0.05)。两组内比较:A组和B组手术后各脊柱测量参数分别与术前比较均显著改善,差异有统计学意义(P<0.05)。两组间比较:术前、术后及末次随访,两组患者冠状面Cobb’s角、腰椎前凸角、冠状面平衡和矢状面平衡差异无统计学意义(P>0.05)。A组早期、晚期及总体并发症发生率分别为6.8%、18.2%和25.0%;B组早期、晚期及总体并发症发生率分别为16.7%、33.3%和50.0%。A组和B组早期和晚期并发症发生率差异无统计学意义,但总体并发症差异有统计学意义。A组最常见的并发症为L5~S1退变;B组则易出现假关节。结论采用后路长节段固定融合手术治疗DLS,严格按照DIV选择的原则,可取得满意的临床疗效且有效降低术后并发症的发生。

Objective To investigate complications following different distal instrumented vertebra(DIV after posterior long segment fixation and fusion for degenerative lumbar scoliosis(DLS).Methods From January 2011 to December 2015,patients with DLS underwent posterior long segment fixation and fusion in our hospital,whose clinical and imaging data were retrospectively reviewed.A total of 74 patients met the inclusion and exclusion criteria.All patients were divided into 2 groups based on the different DIV:group L5(Group A);group S1(Group B).Complications were compared and analyzed between the 2 groups.Group A:11 males and 33 females;mean age(63.23±6.89)years.Group B:8 males and 22 females;mean age(64.28±7.81)years.Hospital records included age,gender,number of decompression and fusion levels,intraoperative blood loss,operation time.Radiographic measurement included coronal Cobb’s angle,lumbar lordosis,coronal and sagittal balance,early perioperative complications(<3 months after the surgery)and late complications(≥3 months after the surgery).Results No statistically significant differences existed between the two groups in the age,gender,operation time,intraoperative blood loss,number of decompression and fusion levels(P>0.05).Postoperative spine parameters improved significantly in both groups respectively compared with the preoperative ones(P<0.05).There were no statistically significant differences in the coronal Cobb’s angle,lumbar lordosis,coronal and sagittal balance(P>0.05)between the 2 groups preoperatively,postoperatively and at the final follow-up.Early,late and overall complication rates in Group A were 6.8%,18.2%and 25.0%,respectively,while in Group B 16.7%,33.3%and 50.0%,respectively.There were no statistically significant differences in the incidence of early and late complications,but significant differences in the overall complication rate between the 2 groups.L5/S1 degeneration was the most common complication in Group A,while pseudarthrosis in Group B.Conclusions Posterior long segment fixation and fusion is reliable and effective in the treatment of DLS,which can achieve satisfactory clinical efficacy and reduce postoperative long-term complications in line with the selection principle of DIV.