后路手术选择性融合固定治疗退变性脊柱侧弯的疗效分析
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摘要
目的探讨后路手术选择性融合固定治疗退变性脊柱侧弯的疗效。方法将80例退变性脊柱侧弯患者随机分为2组。手术组患者给予后路手术选择性融合固定,非手术组患者采用非手术治疗方案。比较2组患者疼痛、脊柱功能、影像学参数与生活质量。结果手术组患者治疗后3个月与末期随访时视觉模拟评分法(VAS)评分、Oswestry功能障碍指数问卷(ODI)评分、Cobb角、冠状面失衡值(CSVL)、顶锥侧方滑移距离(LO)、矢状面失衡值(SVA)与骨盆倾斜角(PT)水平均显著低于非手术组(P <0. 01),日本骨科协会疼痛分数(JOA)评分、腰椎前凸角(LL)与骶骨倾斜角(SS)水平均显著高于非手术组(P <0. 01)。末期随访时,手术组各维度生活质量评分均显著高于非手术组(P <0. 01)。结论后路手术选择性融合固定治疗退变性脊柱侧弯的效果显著。
Objective To investigate the effect of selective fusion and fixation of posterior approach in degenerative scoliosis. Methods A total of 80 degenerative scoliosis patients admitted to our hospital were randomly divided into two groups. The patients in the operation group were treated with posterior fusion and those in the non-surgical group were treated with non-surgical treatment. The pain,spinal function,imaging parameters and quality of life of the two groups were compared. Results The Visual Analogue Score( VAS) score,Oswestry Disability Index score( ODI),Cobb angle,center sacral vertical line( CSVL),lateral slip distance( LO),sagittal vertical axis( SVA) and pelvic tilt( PT) levels in the operation group were significantly lower than that in the non-operation group at 3 months and the end of follow-up,Japan Orthopedic Association Pain Score( JOA),lumbar lordosis( LL) and sacral slope( SS) levels were significantly higher than that of the control group( P < 0. 01). The scores of quality of life in all dimensions were significantly higher than that in the non-operation group( P < 0. 01). Conclusion The degenerative scoliosis posterior surgery by selective fusion fixation has significant efficacy.
Objective To investigate the effect of selective fusion and fixation of posterior approach in degenerative scoliosis. Methods A total of 80 degenerative scoliosis patients admitted to our hospital were randomly divided into two groups. The patients in the operation group were treated with posterior fusion and those in the non-surgical group were treated with non-surgical treatment. The pain,spinal function,imaging parameters and quality of life of the two groups were compared. Results The Visual Analogue Score( VAS) score,Oswestry Disability Index score( ODI),Cobb angle,center sacral vertical line( CSVL),lateral slip distance( LO),sagittal vertical axis( SVA) and pelvic tilt( PT) levels in the operation group were significantly lower than that in the non-operation group at 3 months and the end of follow-up,Japan Orthopedic Association Pain Score( JOA),lumbar lordosis( LL) and sacral slope( SS) levels were significantly higher than that of the control group( P < 0. 01). The scores of quality of life in all dimensions were significantly higher than that in the non-operation group( P < 0. 01). Conclusion The degenerative scoliosis posterior surgery by selective fusion fixation has significant efficacy.
引文
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[13]罗宇,谭家昌,肖奇攀.小切口TLIF结合单侧钉棒及对侧关节突螺钉治疗腰椎退变性疾病[J].实用骨科杂志,2013,19(12):1061-1064.
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[15] Mattei T A. Right L4/L5 Extreme-Lateral Interbody Fusion for Adult Degenerative Scoliosis:When the Black Swan is Too Real[J]. World Neurosurg,2015,84(6):1500-1505.
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[17] Fontes R B,Fessler R G. Lumbar Radiculopathy in the Setting of Degenerative Scoliosis:MIS Decompression and Limited Correction are Better Options[J]. Neurosurg Clin N Am,2017,28(3):335-339.
[18]焦建宝,郭召,薛金伟,等.有限减压及选择性固定、融合、矫形术治疗退行性腰椎侧凸合并骨质疏松症[J].山东医药,2011,51(36):90-92.
[19]崔雅清,王江华.经皮椎体成形术治疗多节段脊柱转移性肿瘤的疗效及护理干预[J].实用临床医药杂志,2017,21(12):80-83.
[20]王诗军,李钰婷,李淳德.脊柱侧弯内固定系统置入及三维重建技术的应用[J].中国组织工程研究,2016,20(4):583-588.
[2]陈萧霖,陈仲强,曾岩,等.成人退变性脊柱侧弯长节段固定融合术后远期并发症研究进展[J].国际骨科学杂志,2017,38(1):22-27.
[3]楼肃亮,郑杰,杨永宏.长节段固定融合术治疗退变性脊柱侧弯术后并发症分析[J].中国医师进修杂志,2013,36(23):20-22.
[4]柯广水,夏磊.长节段固定融合在治疗退变性脊柱侧弯中的疗效分析[J].中国实用医刊,2015,42(6):10-11.
[5] Zheng J,Yang Y,Lou S,et al. Construction and Validation of a Three-Dimensional Finite Element Model of Degenerative Scoliosis[J]. J Orthop Surg Res,2015,10:189-191.
[6]胡臻,尹邦良,吕国华,等.成人退行性腰椎侧弯合并滑脱的手术治疗[J].现代生物医学进展,2010,10(11):2083-2085.
[7] Baudracco I,Russo V M,Dhawan R T,et al. Hybrid bone HDP SPECT/CT in evaluation of painful degenerative scoliosis[J]. Spine J,2016,16(7):e419-e420.
[8]段丽群,张文志.动态稳定非融合技术与后路固定融合技术治疗老年退变性脊柱侧弯的对比研究[J].临床骨科杂志,2013,16(3):320-321.
[9]丁金勇,洪少勇,晋大祥,等.骨水泥强化治疗骨质疏松症伴脊柱侧弯疗效分析[J].颈腰痛杂志,2012,33(2):117-121.
[10]刘宁,吴鹏,吴义刚.腰椎后路减压椎间融合内固定患者采用FTS理念治疗的临床效果[J].宁夏医科大学学报,2016,38(8):958-960.
[11] Zhu Y,Wang K,Wang B,et al. Selection of Proximal Fusion Level for Degenerative Scoliosis and the Entailing Proximal-Related Late Complications[J]. Int J Clin Exp Med,2015,8(4):5731-5738.
[12]周志刚,李志忠,焦根龙,等.后路手术治疗退变性腰椎侧弯疗效观察[J].山东医药,2011,51(10):45-46.
[13]罗宇,谭家昌,肖奇攀.小切口TLIF结合单侧钉棒及对侧关节突螺钉治疗腰椎退变性疾病[J].实用骨科杂志,2013,19(12):1061-1064.
[14]苏士乐,刘浩,章宏志,等.选择性短节段固定融合治疗退行性脊柱侧弯[J].颈腰痛杂志,2014,35(6):435-437.
[15] Mattei T A. Right L4/L5 Extreme-Lateral Interbody Fusion for Adult Degenerative Scoliosis:When the Black Swan is Too Real[J]. World Neurosurg,2015,84(6):1500-1505.
[16]关永林,赵学权,王振东,等.后路椎弓根钉棒固定治疗退变性脊柱侧弯的临床疗效[J].临床骨科杂志,2016,19(3):287-289.
[17] Fontes R B,Fessler R G. Lumbar Radiculopathy in the Setting of Degenerative Scoliosis:MIS Decompression and Limited Correction are Better Options[J]. Neurosurg Clin N Am,2017,28(3):335-339.
[18]焦建宝,郭召,薛金伟,等.有限减压及选择性固定、融合、矫形术治疗退行性腰椎侧凸合并骨质疏松症[J].山东医药,2011,51(36):90-92.
[19]崔雅清,王江华.经皮椎体成形术治疗多节段脊柱转移性肿瘤的疗效及护理干预[J].实用临床医药杂志,2017,21(12):80-83.
[20]王诗军,李钰婷,李淳德.脊柱侧弯内固定系统置入及三维重建技术的应用[J].中国组织工程研究,2016,20(4):583-588.