根据症状特点选择术式治疗退行性脊柱侧凸的3～7年随访
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摘要
目的:评估依据症状特点选择术式治疗退行性脊柱侧凸的3～7年随访结果。方法:61例退行性脊柱侧凸患者,依据症状分为A组(腰背痛为主)20例,行长节段矫形内固定术;B组(下肢根性症状为主)41例,行责任节段减压内固定术。采用VAS评分、ODI量表评估疼痛和功能改善情况。结果:随访39～79个月,平均55.5个月;两组末次随访时VAS和ODI评分与术前相比差异有统计学意义(P<0.05),组间比较差异有统计学意义(P<0.05),A组优于B组。围手术期A组出现并发症2例,末次随访时B组出现邻近节段退变14例。结论:3～7年随访发现:依据症状选择术式治疗退行性脊柱侧凸,长节段组疗效优于责任节段组;责任节段组邻近节段退变发生率较高,其远期疗效仍需进一步观察。
Objective:To evaluate the 3～7 years follow-up results of different surgical treatment for degenerative scoliosis based on symptom characteristics.Methods:61degenerative scoliosis patients were divided into two groups according on clinical symptoms.Group A(the main symptom is low back pain)has 20 cases,performed long segment internal fixation and correction;group B(the main symptoms lower limbs discomforts)has 41 cases,performed posterior responsibility segments decompression and fusion.The VAS score,Oswestry disability index(ODI)were used to evaluated the clinical outcomes.Results:After 3～7 years follow-up,the two groups' VAS,ODI scores compared with before were statistically significant(P<0.05),the two groups' VAS,ODI scores compared with each other were statistically significant(P<0.05).Complications occurred in 2cases in group A during perioperative period and 14 cases in group B at the last followup.Conclusion:The 3～7years follow-up results show that the effect of long segment group is reliable;the incidence of adjacent segment degeneration of responsibility segment group is higher,so its long-term effect still needed to be further observed.
Objective:To evaluate the 3～7 years follow-up results of different surgical treatment for degenerative scoliosis based on symptom characteristics.Methods:61degenerative scoliosis patients were divided into two groups according on clinical symptoms.Group A(the main symptom is low back pain)has 20 cases,performed long segment internal fixation and correction;group B(the main symptoms lower limbs discomforts)has 41 cases,performed posterior responsibility segments decompression and fusion.The VAS score,Oswestry disability index(ODI)were used to evaluated the clinical outcomes.Results:After 3～7 years follow-up,the two groups' VAS,ODI scores compared with before were statistically significant(P<0.05),the two groups' VAS,ODI scores compared with each other were statistically significant(P<0.05).Complications occurred in 2cases in group A during perioperative period and 14 cases in group B at the last followup.Conclusion:The 3～7years follow-up results show that the effect of long segment group is reliable;the incidence of adjacent segment degeneration of responsibility segment group is higher,so its long-term effect still needed to be further observed.
引文
[1] XU L L,SUN X,HUANG S S,et al.Degenerative lumbar scoliosis in Chinese Han population:prevalence and relationship to age,gender,bone mineral density and body mass index[J].Eur Spine J,2013,22:1326-1331.
[2]王振东,雒永生,曹旭阳,等.退行性脊柱侧凸的研究进展[J].实用中西医结合临床,2017,7(1):162-165.
[3] YANG Y H,ZHENG J,LOU S L.Medium to long-term curative effects of long-segmental fixation and fusion on degenerative scoliosis[J].Int J Clin Exp Med,2015,8(5):8129-8134.
[4]孙武,朱立国,高景华,等.根据症状特点选择术式治疗退行性脊柱侧凸的疗效观察[J].中国中医骨伤科杂志,2016,24(6):29-33.
[5]胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2005:1732-1733.
[6] CARLSSON A M.Assessment of chronic pain:aspects of the reliability and validity of the visual analogue scale[J].Pain,1983,16(1):87-101.
[7] FAIRBANK J C.Oswestry disability index[J].J Neourosurg Spine,2014,20(2):239-241.
[8] DAUBS M D,LENKE L G,BRIDWELL K H,et al.Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient[J].Evid Based Spine Care J,2012,3(4):27-32.
[9]钱宇锋,薛峰,盛晓文,等.短节段减压融合治疗退变性腰椎侧凸症术后侧凸影像学发展的观察研究[J].颈腰痛杂志,2016,37(1):53-56.
[10]王华东,吴闻文,李利,等.退变性腰椎侧凸不同手术方式的适应证选择[J].中国骨与关节杂志,2015,4(3):172-175.
[11]SILVA F E,LENKE L G.Adult degenerative scoliosis:evaluation and management[J].Neurosurg Focus,2010,28(3):E1.
[12]王孝宾,吕国华,王冰,等.后路长节段固定治疗成人退行性脊柱畸形的疗效及其远端并发症[J].中国脊柱脊髓杂志,2016,26(8):689-695.
[13]张志平,郭昭庆,孙垂国,等.退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理[J].中国脊柱脊髓杂志,2014,24(10):906-911.
[14]姜传杰,杨永军,谭远超,等.成人退变性脊柱侧凸的研究进展[J].中国中医骨伤科杂志,2014,22(5):75-78.
[15]GILLESPY T 3rd,GILLESPY T Jr,REVAK C S.Progressive senile scoliosis:seven cases of increasing spinal curves in elderly patients[J].Skeletal Radiol,1985,13:280-286.
[16]LAMARTINA C,BERJANO P,PETRUZZI M,et al.Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis[J].Eur Spine J,2012,21(S1):27-31.
[2]王振东,雒永生,曹旭阳,等.退行性脊柱侧凸的研究进展[J].实用中西医结合临床,2017,7(1):162-165.
[3] YANG Y H,ZHENG J,LOU S L.Medium to long-term curative effects of long-segmental fixation and fusion on degenerative scoliosis[J].Int J Clin Exp Med,2015,8(5):8129-8134.
[4]孙武,朱立国,高景华,等.根据症状特点选择术式治疗退行性脊柱侧凸的疗效观察[J].中国中医骨伤科杂志,2016,24(6):29-33.
[5]胥少汀,葛宝丰,徐印坎.实用骨科学[M].3版.北京:人民军医出版社,2005:1732-1733.
[6] CARLSSON A M.Assessment of chronic pain:aspects of the reliability and validity of the visual analogue scale[J].Pain,1983,16(1):87-101.
[7] FAIRBANK J C.Oswestry disability index[J].J Neourosurg Spine,2014,20(2):239-241.
[8] DAUBS M D,LENKE L G,BRIDWELL K H,et al.Decompression alone versus decompression with limited fusion for treatment of degenerative lumbar scoliosis in the elderly patient[J].Evid Based Spine Care J,2012,3(4):27-32.
[9]钱宇锋,薛峰,盛晓文,等.短节段减压融合治疗退变性腰椎侧凸症术后侧凸影像学发展的观察研究[J].颈腰痛杂志,2016,37(1):53-56.
[10]王华东,吴闻文,李利,等.退变性腰椎侧凸不同手术方式的适应证选择[J].中国骨与关节杂志,2015,4(3):172-175.
[11]SILVA F E,LENKE L G.Adult degenerative scoliosis:evaluation and management[J].Neurosurg Focus,2010,28(3):E1.
[12]王孝宾,吕国华,王冰,等.后路长节段固定治疗成人退行性脊柱畸形的疗效及其远端并发症[J].中国脊柱脊髓杂志,2016,26(8):689-695.
[13]张志平,郭昭庆,孙垂国,等.退变性腰椎疾患后路减压术后脑脊液漏的相关因素分析及处理[J].中国脊柱脊髓杂志,2014,24(10):906-911.
[14]姜传杰,杨永军,谭远超,等.成人退变性脊柱侧凸的研究进展[J].中国中医骨伤科杂志,2014,22(5):75-78.
[15]GILLESPY T 3rd,GILLESPY T Jr,REVAK C S.Progressive senile scoliosis:seven cases of increasing spinal curves in elderly patients[J].Skeletal Radiol,1985,13:280-286.
[16]LAMARTINA C,BERJANO P,PETRUZZI M,et al.Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis[J].Eur Spine J,2012,21(S1):27-31.