摘要
目的比较研究接受两种治疗策略(长节段彻底重建与短节段有限干预)的成人退变性脊柱侧凸(adult degenerative scoliosis,ADS)患者术后中长期疗效、并发症及二次手术情况。方法回顾性研究2011年6月至2018年6月,于我院接受手术治疗的78例Lenke-Silva分级在Ⅲ级及以上的ADS患者。根据手术节段数分为长节段组(≥3)和短节段组(<3)。对两组患者年龄、性别、固定节段数等一般资料,相关症状,疼痛视觉模拟评分(visual analogue scale,VAS),影像学指标及二次手术情况进行比较分析。结果两组患者在性别、随访时间、远期总并发症及二次手术率方面差异无统计学意义(P>0.05)。长节段组平均年龄(57.1±7.9)岁,固定节段(7.9±2.4)个,术前冠状面Cobb’s角、腰椎前凸角、矢状面平衡及腰痛VAS评分较短节段组差(P<0.05);短节段组平均年龄(60.8±8.4)岁,固定节段(1.4±0.5)个,末次随访时冠状面Cobb’s角、腰椎前凸角和矢状面平衡较长节段组差(P<0.05)。长节段组内置物相关并发症发生率更高(P=0.010);短节段组邻近节段相关并发症与长节段组差异无统计学意义(P=0.068)。结论对无法耐受长节段手术的患者,短节段有限手术是更加合理的治疗策略。它并不增加术后二次手术的发生率,且患者疗效的改善和维持与长节段策略无异。
Objective To explore the medium-and long-term postoperative efficacy,complications and secondary surgery rate of adult degenerative scoliosis(ADS)by thorough or limited intervention.Methods A retrospective study was conducted on 78 ADS patients with Lenke-Silva levelⅢand above from June 2011 to June 2018.According to the number of operative segments(≥3 or<3),all patients were divided into long-segmental strategy and short-segmental strategy group.General data,VAS,imaging parameters and secondary operation were compared and analyzed between the two groups.Results There were no significant differences in sex,follow-up time,total long-term complications and secondary operation rate between the two groups(P=0.416,P=0.556,P=0.0886,P=1.000).The average age of the long-segmental strategy group was(57.1±7.9)years;the average number of fixed segments was(7.9±2.4);the preoperative coronal Cobb’s angle,lumbar lordosis angle,sagittal plane balance and VAS of the long segment group were worse than those of the short-segmental group(P=0.015,0.036,0.000 and 0.000).The average age of the short-segmental strategy group was(60.8±8.4)years;the average number of fixed segments was(1.4±0.5);at the last follow-up,the coronal Cobb’s angle,lumbar lordosis angle and sagittal plane balance were worse than that of the long-segmental group(P=0.000,0.025 and 0.001).The incidence of complications related to long-segmental strategy was higher than that of the short-segmental strategy(P=0.010),however,there were no significant differences in adjacent segment related complications between the two groups(P=0.068).Conclusions Short-segmental limited intervention is more reasonable for elder patients with multiple preoperative diseases,which will not increase the incidence of postoperative secondary surgery while maintain similar effects as long-segmental strategy.
作者
宋智博
王迎松
解京明
张颖
赵智
李韬
武学才
毕尼
SONG Zhi-bo;WANG Ying-song;XIE Jing-ming;ZHANG Ying;ZHAO Zhi;LI Tao;WU Xue-cai;BI Ni(Department of Orthopedics,The 2nd Affiliated Hospital of Kunming Medical University,Kunming,Yunnan,650101,China)
出处
《中国骨与关节杂志》
CAS
2021年第10期759-765,共7页
Chinese Journal of Bone and Joint
基金
国家自然科学基金(81960413)。
关键词
脊柱侧凸
脊柱疾病
矫形外科手术
手术后并发症
Scoliosis
Spinal diseases
Orthopedic procedures
Postoperative complications
