重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后
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摘要
目的探讨重度特发性胸腰段脊柱侧凸患者应用前后路手术联合内固定的疗效及预后。方法选择60例重度特发性胸腰段脊柱侧凸患者,随机分为2组。前后路组患者给予前后路联合内固定术,后路组患者给予后路联合内固定术。观察2组患者治疗情况、术前术后指标变化及随访情况。结果 2组患者手术时间、出血量、住院时间比较有显著差异(P<0.05);2组患者融合节段无显著差异(P>0.05)。2组术后主弯Cobb角、后凸角及躯干偏移均有显著改善(P<0.05)。2组末次随访主弯Cobb角丢失度数、后凸丢失度数、主弯Cobb角矫正率、后凸矫正率无显著差异(P>0.05)。结论前后路联合内固定术与后路联合内固定术对重度特发性胸腰段脊柱侧凸患者治疗效果相当,后路联合内固定术手术时间与住院时间更短,但出血量更大,风险更高。
Objective To investigate the effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis.Methods A total of 60 patients with severe idiopathic thoracolumbar scoliosis were randomly divided into two groups. The anterior and posterior group was treated with anterior and posterior internal fixation,and posterior group was treated with posterior combined with internal fixation. Effect,preoperative and postoperative indicators and condition during follow-up were observed. Results There were significant differences in operation time,blood loss,length of stay between two groups( P < 0. 05).There was no significant difference of fusion segments between two groups( P > 0. 05). There were significant differences in the main bending angle Cobb,kyphosis and trunk shift between two groups(P < 0. 05). There were no significant differences in the final follow-up Cobb angle loss,the degree of kyphosis loss,the correction rate of Cobb angle and the correction rate of kyphosis between two groups(P > 0. 05). Conclusion Anterior combined with posterior internal fixation is similar to posterior internal fixation in treatment of patients with severe idiopathic thoracolumbar scoliosis,but the operation time and hospital stay are shorter by posterior internal fixation,and the amount of bleeding is greater and the risk is higher.
Objective To investigate the effect and prognosis of anterior posterior surgery combined with internal fixation on treatment of patients with severe idiopathic thoracolumbar scoliosis.Methods A total of 60 patients with severe idiopathic thoracolumbar scoliosis were randomly divided into two groups. The anterior and posterior group was treated with anterior and posterior internal fixation,and posterior group was treated with posterior combined with internal fixation. Effect,preoperative and postoperative indicators and condition during follow-up were observed. Results There were significant differences in operation time,blood loss,length of stay between two groups( P < 0. 05).There was no significant difference of fusion segments between two groups( P > 0. 05). There were significant differences in the main bending angle Cobb,kyphosis and trunk shift between two groups(P < 0. 05). There were no significant differences in the final follow-up Cobb angle loss,the degree of kyphosis loss,the correction rate of Cobb angle and the correction rate of kyphosis between two groups(P > 0. 05). Conclusion Anterior combined with posterior internal fixation is similar to posterior internal fixation in treatment of patients with severe idiopathic thoracolumbar scoliosis,but the operation time and hospital stay are shorter by posterior internal fixation,and the amount of bleeding is greater and the risk is higher.
引文
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[11]王庆伟,董献成,茹江英,等.骨质疏松尸体椎体中可灌注骨水泥椎弓根螺钉和可膨胀式椎弓根螺钉的生物力学研究[J].实用临床医药杂志,2016,20(09):105-108.
[12]曹参,吴继功,马华松,等.前后路联合与后路截骨矫形治疗重度僵硬性特发性胸腰段脊柱侧凸的疗效对比?[J].中国矫形外科杂志,2013,21(19):1923-1928.
[13]周春光,宋跃明.重度僵硬性脊柱侧凸矫正技术进展[J].中国修复重建外科杂志,2012,26(2):238-243.
[14]曾义高,方丁,贺志强.前路与后路减压内固定治疗胸腰椎爆裂骨折并脊髓损伤的比较[J].中国骨与关节损伤杂志,2016,31(01):73-74.
[2]张宏其,郭强,郭超峰,等.单纯后路、单纯前路或前后联合入路治疗成人腰椎结核的中期疗效比较[J].中华骨科杂志,2016,36(11):651-661.
[3]Qiu Y,Wang W J,Zhu F,et al.Anterior endoscopic release/posterior spinal instrumentation for severe and rigid thoracic adolescent idiopathic scoliosis[J].Zhonghua Wai ke Za zhi,2011,4(12):1071-1075.
[4]刘臻,刘勇,朱泽章,等.青少年脊柱侧凸合并腰椎滑脱的术式选择[J].中国脊柱脊髓杂志,2014,24(06):481-486.
[5]孙经昊,高吉昌,王仑,等.滑动椎弓根钉棒系统治疗青少年脊柱侧凸畸形的研究[J].颈腰痛杂志,2015,32(03):184-187.
[6]Yoon W W,Sedra F,Shah S.Improvement of pulmonary function in children with early-onset scoliosis using magnetic growth rods[J].Spine,2014,39(15):1196-1202.
[7]史本龙,朱泽章,邱勇.青少年特发性脊柱侧凸矫形术后中长期随访研究回顾[J].中华医学杂志,2016,96(40):3277-3279.
[8]张宏其,余洪贵,王昱翔,等.大重量Halo-股骨髁上牵引在治疗重度僵硬性特发性脊柱侧凸中的矫形贡献率分析?[J].中华骨科杂志,2016,36(20):1277-1283.
[9]Takayuki S,Maiko H M,Tohko Y,et al.A Case of Liver Contusion during Spinal Operation for Idiopathic Scoliosis[J].Masui The Japanese journal of anesthesiology,2015,64(4):437-440.
[10]程正亮.前后入路减压内固定治疗胸腰椎爆裂骨折合并脊髓损伤的疗效比较[J].湖南师范大学学报:医学版,2016,13(03):72-73.
[11]王庆伟,董献成,茹江英,等.骨质疏松尸体椎体中可灌注骨水泥椎弓根螺钉和可膨胀式椎弓根螺钉的生物力学研究[J].实用临床医药杂志,2016,20(09):105-108.
[12]曹参,吴继功,马华松,等.前后路联合与后路截骨矫形治疗重度僵硬性特发性胸腰段脊柱侧凸的疗效对比?[J].中国矫形外科杂志,2013,21(19):1923-1928.
[13]周春光,宋跃明.重度僵硬性脊柱侧凸矫正技术进展[J].中国修复重建外科杂志,2012,26(2):238-243.
[14]曾义高,方丁,贺志强.前路与后路减压内固定治疗胸腰椎爆裂骨折并脊髓损伤的比较[J].中国骨与关节损伤杂志,2016,31(01):73-74.