中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2015年
11期
1186-1190
,共5页
马超%李利%史亚民%王华东%侯树勋%郭继东
馬超%李利%史亞民%王華東%侯樹勛%郭繼東
마초%리리%사아민%왕화동%후수훈%곽계동
脊柱侧凸%脊柱融合术%内固定
脊柱側凸%脊柱融閤術%內固定
척주측철%척주융합술%내고정
Scoliosis%Spinal fusion%Internal fixators
目的 探讨减压后长节段与短节段融合对成年人退变性脊柱侧凸(ADS)的手术疗效的影响. 方法 回顾性研究2013年4月至2015年5月在我院收治的ADS患者32例,其中男12例,女20例;平均年龄66.4岁.患者均行后路减压、固定融合术.根据融合范围分为长节段组与短节段组,术前、术后1年及2年随访临床疗效及影像学情况.临床疗效评价采用视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI).影像学评估行站立位全脊柱正侧位X线片,测量冠状面Cobb角、颈7铅垂线-骶骨中垂线间距(C7PL-CSVL),及矢状面的胸椎后凸(TK)、腰椎前凸(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、PI-LL差、矢状轴距离(SVA).记录术后并发症发生情况. 结果 平均随访2.2年(1.5～3.5年).长节段组22例(68.8％),短节段组10例(31.2％),两组在年龄、性别差异无统计学意义(P=0.066、0.182).融合节段:长节段组平均(6.3士1.5)个,短节段组平均(2.9土0.3)个,差异有统计学意义(P=0.001).长节段组的手术时间、术中出血量[分别为(255.3±31.8)min,(686.3±80.5) ml]均大于短节段组[分别为(170.3±18.5) min,(330.5±30.6) ml](均P＜0.05).两组患者术后腰痛VAS评分、腿痛VAS评分、ODI指数均较术前明显改善(P＜0.05);末次随访时长节段组腰痛VAS评分大于短节段组(P＜0.05),但腿痛VAS评分两组间差异无统计学意义(P＞0.05),长节段组ODI值改善好于短节段组(P＜0.05).术前Cobb角两组间差异无统计学意义(P＞0.05);术后Cobb角长节段组矫正好于短节段组(P＜0.001).手术后长节段组C7-CSVL间距明显改善(P＜0.05);而短节段组改善不明显(P＜0.05).长节段组术后可有效增加腰椎前凸、恢复正常脊柱序列.术后并发症总体发生率31.3％,包括伤口感染、脑脊液漏、一过性神经症状及内固定棒断裂,长节段组多于短节段组. 结论 减压、融合内固定治疗ADS疗效满意.长节段固定融合冠状面及矢状面矫形效果好,但围术期风险高;短节段固定融合矫形效果弱,但相对安全.应当根据患者病情选择合适内固定方式.
目的 探討減壓後長節段與短節段融閤對成年人退變性脊柱側凸(ADS)的手術療效的影響. 方法 迴顧性研究2013年4月至2015年5月在我院收治的ADS患者32例,其中男12例,女20例;平均年齡66.4歲.患者均行後路減壓、固定融閤術.根據融閤範圍分為長節段組與短節段組,術前、術後1年及2年隨訪臨床療效及影像學情況.臨床療效評價採用視覺模擬評分(VAS)和Oswestry功能障礙指數(ODI).影像學評估行站立位全脊柱正側位X線片,測量冠狀麵Cobb角、頸7鉛垂線-骶骨中垂線間距(C7PL-CSVL),及矢狀麵的胸椎後凸(TK)、腰椎前凸(LL)、骨盆入射角(PI)、骨盆傾斜角(PT)、PI-LL差、矢狀軸距離(SVA).記錄術後併髮癥髮生情況. 結果 平均隨訪2.2年(1.5～3.5年).長節段組22例(68.8％),短節段組10例(31.2％),兩組在年齡、性彆差異無統計學意義(P=0.066、0.182).融閤節段:長節段組平均(6.3士1.5)箇,短節段組平均(2.9土0.3)箇,差異有統計學意義(P=0.001).長節段組的手術時間、術中齣血量[分彆為(255.3±31.8)min,(686.3±80.5) ml]均大于短節段組[分彆為(170.3±18.5) min,(330.5±30.6) ml](均P＜0.05).兩組患者術後腰痛VAS評分、腿痛VAS評分、ODI指數均較術前明顯改善(P＜0.05);末次隨訪時長節段組腰痛VAS評分大于短節段組(P＜0.05),但腿痛VAS評分兩組間差異無統計學意義(P＞0.05),長節段組ODI值改善好于短節段組(P＜0.05).術前Cobb角兩組間差異無統計學意義(P＞0.05);術後Cobb角長節段組矯正好于短節段組(P＜0.001).手術後長節段組C7-CSVL間距明顯改善(P＜0.05);而短節段組改善不明顯(P＜0.05).長節段組術後可有效增加腰椎前凸、恢複正常脊柱序列.術後併髮癥總體髮生率31.3％,包括傷口感染、腦脊液漏、一過性神經癥狀及內固定棒斷裂,長節段組多于短節段組. 結論 減壓、融閤內固定治療ADS療效滿意.長節段固定融閤冠狀麵及矢狀麵矯形效果好,但圍術期風險高;短節段固定融閤矯形效果弱,但相對安全.應噹根據患者病情選擇閤適內固定方式.
목적 탐토감압후장절단여단절단융합대성년인퇴변성척주측철(ADS)적수술료효적영향. 방법 회고성연구2013년4월지2015년5월재아원수치적ADS환자32례,기중남12례,녀20례;평균년령66.4세.환자균행후로감압、고정융합술.근거융합범위분위장절단조여단절단조,술전、술후1년급2년수방림상료효급영상학정황.림상료효평개채용시각모의평분(VAS)화Oswestry공능장애지수(ODI).영상학평고행참립위전척주정측위X선편,측량관상면Cobb각、경7연수선-저골중수선간거(C7PL-CSVL),급시상면적흉추후철(TK)、요추전철(LL)、골분입사각(PI)、골분경사각(PT)、PI-LL차、시상축거리(SVA).기록술후병발증발생정황. 결과 평균수방2.2년(1.5～3.5년).장절단조22례(68.8％),단절단조10례(31.2％),량조재년령、성별차이무통계학의의(P=0.066、0.182).융합절단:장절단조평균(6.3사1.5)개,단절단조평균(2.9토0.3)개,차이유통계학의의(P=0.001).장절단조적수술시간、술중출혈량[분별위(255.3±31.8)min,(686.3±80.5) ml]균대우단절단조[분별위(170.3±18.5) min,(330.5±30.6) ml](균P＜0.05).량조환자술후요통VAS평분、퇴통VAS평분、ODI지수균교술전명현개선(P＜0.05);말차수방시장절단조요통VAS평분대우단절단조(P＜0.05),단퇴통VAS평분량조간차이무통계학의의(P＞0.05),장절단조ODI치개선호우단절단조(P＜0.05).술전Cobb각량조간차이무통계학의의(P＞0.05);술후Cobb각장절단조교정호우단절단조(P＜0.001).수술후장절단조C7-CSVL간거명현개선(P＜0.05);이단절단조개선불명현(P＜0.05).장절단조술후가유효증가요추전철、회복정상척주서렬.술후병발증총체발생솔31.3％,포괄상구감염、뇌척액루、일과성신경증상급내고정봉단렬,장절단조다우단절단조. 결론 감압、융합내고정치료ADS료효만의.장절단고정융합관상면급시상면교형효과호,단위술기풍험고;단절단고정융합교형효과약,단상대안전.응당근거환자병정선택합괄내고정방식.
Objective To investigate the effect of decompression with long-segment (L) or short-segment (S) fusion on the outcomes of the surgical treatment for degenerative adult scoliosis (ADS) patiens.Methods A retrospective study on 32 patients treated in our department for ADS from April 2013 to May 2015 was carried out, including 12 male and 20 female (1 : 1.7).Their average age was 66.4 (range: 51-77 years).All patients underwent decompression and fusion surgeries through posterior approach.They were divided into long-segment fusion group (L) and short-segment fusion group (S) according to fusion range.During follow-ups (FU), clinical outcomes were assessed by means of visual analog scale (VAS) and Oswestry disability index (ODI).Radiographic evaluation on full-length standing film included coronal Cobb's angle, distant between C7plumb line and center sacral vertical line (C7PL-CSVL), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, pelvic incidence (PI), and pelvic tilt (PT), PI-LL, sagittal vertical axis(SVA).Postoperative complications were also recorded.Results All patients were followed up for average 2.2 years (range:1.5-3.5 years).No significant difference of age or gender was found between two groups (L: 22, S:10) of patients (P=0.066, 0.182).As for the fusion segments, group L (6.3±1.5) was more than group S (2.9±0.3) (P=0.001).Operation time and blood loss of group L were statistically more than group S (P＜0.05).Postoperative VAS sores of back pain and leg pain as well as ODI were all improved significantly in two groups (P＜0.05).At the final FU, back pain VAS was more in group L than in group S (P＜0.05) , but no significant difference was found in leg pain VAS between two groups (P＞0.05);at the final FU, group L's ODI showed better functional recovery than group S's[(12.8±9.3)％ vs.(25.4±11.4)％, P＜0.05].With no obvious difference in the two groups (P＞0.05), coronal Cobb's angle corrected more satisfactional in group L than group S (P＜0.05).The same situation was found in C7-CSVL correction in two goup in FU (P＜0.05).Sagital balance was restored to normal alignment better in group L than group S, with increase of lumbar lordosis after surgery.The overall incidence of postoperative complications was 31.3％, including wound infection, cerebrospinal fluid leakage, transient neurological symptoms and internal fixed rod breakage, more common in group L than group S.Conclusions Decompression and fusion with internal fixation showed good clinical outcomes in the treatment of ADS.Long-segment fusion yielded better coronal and sagittal correction outcomes with higher peri-operation risks;however, short-segment fusion showed higher safety with relatively inferior correction effect.Appropriate fusion mode should be chose according to the patient's deformity features.
