Yee A J, Yoo J U, Marsolais E B, Carlson G, Poe-Kochert C, Bohlman H H, Emery S E
The Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, Toronto, ON M4N 3M5, Canada.
J Bone Joint Surg Am. 2008 Oct;90(10):2062-8. doi: 10.2106/JBJS.G.01093.
Lumbosacral corsets and braces have been used to treat a variety of spinal disorders. Although their use after lumbar arthrodesis for degenerative conditions has been reported, there is a lack of evidence on which to base guidelines on their use. The purpose of this study was to evaluate the effect of a postoperative corset on the outcome of lumbar arthrodesis.
A prospective randomized trial was performed in which patients who wore a postoperative lumbar corset for eight weeks full-time after a posterior lumbar arthrodesis for a degenerative spinal condition were compared with those who did not use a corset after such an operation. Ninety patients were randomized to one of the two treatments. A history was recorded and patients were assessed with a physical examination, radiographs, and functional outcome questionnaires (the Dallas Pain Questionnaire [DPQ] and the Short Form-36 [SF-36]) preoperatively and at one year and two years following the surgery. The primary outcome measure of the study was the DPQ, a disease-specific patient-derived functional measure of the spine, and secondary end points included the SF-36 scores, complications, rates of fusion as determined radiographically, and reoperation rates.
Follow-up analysis was performed for seventy-two patients, thirty-seven randomized to the brace (experimental) group and thirty-five randomized to the control group. Regardless of the treatment method, the patients had substantial improvement in the disease-specific and general health measures by two years postoperatively. At two years, there was no difference in the DPQ category scores (the primary outcome parameter) of the two treatment groups. There was also no difference in the mean SF-36 component scores at two years. Postoperative complications occurred in 22% and 23% of patients in the experimental and control groups, respectively, and a subsequent lumbar spinal operation was performed in 19% and 14%, respectively. Seven patients (five in the experimental group and two in the control group) with radiographic evidence of nonunion underwent revision surgery.
This study does not indicate a significant advantage or disadvantage to the use of a postoperative lumbar corset following spinal arthrodesis for degenerative conditions of the lumbar spine.
Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
腰骶部束腹带和支具已被用于治疗多种脊柱疾病。虽然已有关于其在腰椎融合术后用于退行性疾病的报道，但缺乏制定使用指南的依据。本研究的目的是评估术后束腹带对腰椎融合术疗效的影响。
进行了一项前瞻性随机试验，将因退行性脊柱疾病接受后路腰椎融合术后全职佩戴术后腰椎束腹带8周的患者与术后不使用束腹带的患者进行比较。90例患者被随机分为两种治疗方法之一。记录病史，并在术前以及术后1年和2年对患者进行体格检查、影像学检查和功能结局问卷调查（达拉斯疼痛问卷[DPQ]和简明健康状况调查量表[SF-36]）。该研究的主要结局指标是DPQ，这是一种源自患者的针对脊柱疾病的功能测量指标，次要终点包括SF-36评分、并发症、影像学确定的融合率和再次手术率。
对72例患者进行了随访分析，其中37例随机分配至支具（试验）组，35例随机分配至对照组。无论采用何种治疗方法，患者在术后两年时疾病特异性和总体健康指标均有显著改善。两年时，两个治疗组的DPQ类别评分（主要结局参数）无差异。两年时平均SF-36分量表评分也无差异。试验组和对照组分别有22%和23%的患者发生术后并发症，随后分别有19%和14%的患者接受了腰椎手术。7例（试验组5例，对照组2例）有影像学证据显示未融合的患者接受了翻修手术。
本研究未表明腰椎融合术后使用术后腰椎束腹带存在显著优势或劣势。
治疗性I级。有关证据水平的完整描述，请参阅作者须知。
