退变性腰椎滑脱症与腰椎管狭窄症：滑脱是否有影响？基线特征和结局的比较（SPORT）。
Degenerative spondylolisthesis versus spinal stenosis: does a slip matter? Comparison of baseline characteristics and outcomes (SPORT).
机构信息
Department of Orthopaedics, Dartmouth Medical School, Lebanon, NH 03756, USA.
出版信息
Spine (Phila Pa 1976). 2010 Feb 1;35(3):298-305. doi: 10.1097/BRS.0b013e3181bdafd1.
STUDY DESIGN
As-treated analysis of the Spine Patient Outcomes Research Trial.
OBJECTIVE
To compare baseline characteristics and surgical and nonoperative outcomes between degenerative spondylolisthesis (DS) and spinal stenosis (SPS) patients.
SUMMARY OF BACKGROUND DATA
DS and SPS patients are often combined in clinical studies despite differences in underlying pathology and treatment.
METHODS
The DS cohort included 601 patients (369 [61%] underwent surgery), and the SPS cohort included 634 patients (394 [62%] underwent surgery). Baseline characteristics were compared between the 2 groups. Changes from baseline for surgical and nonoperative outcomes were compared at 1 and 2 years using longitudinal regression models. Primary outcome measures included the SF-36 bodily pain and physical function scores and the Oswestry Disability Index.
RESULTS
The DS patients included more females (69% vs. 39%, P < 0.001), were older (66.1 year vs. 64.6 years, P = 0.021), and were less likely to have multilevel stenosis (35% vs. 61%, P < 0.001) compared with the SPS patients. There were no significant baseline differences on any of the main outcome measures. DS patients undergoing surgery were much more likely to be fused than SPS patients (94% vs. 11%, P < 0.001) and improved more with surgery than SPS patients on all primary outcome measures (DS vs. SPS): physical function (+30.4 vs. +25.3, P = 0.004 at 1 year; + 28.3 vs. +21.4, P < 0.001 at 2 years), bodily pain (+32.3 vs. +27.5, P = 0.006 at 1 year; +31.1 vs. +26.1, P = 0.003 at 2 years), and Oswestry Disability Index (-25.9 vs. -21.0, P < 0.001 at 1 year; -24.7 vs. -20.2, P < 0.001 at 2 years). Patients treated nonoperatively improved less than those treated surgically, and there were no significant differences in nonoperative outcomes between the 2 cohorts.
CONCLUSION
Overall, DS and SPS patients had similar baseline characteristics. However, DS patients improved more with surgery than SPS patients. Future studies should probably not combine these heterogeneous patient populations.
研究设计
脊柱患者结局研究试验的按处理分析。
目的
比较退行性脊椎滑脱症（DS）和椎管狭窄症（SPS）患者的基线特征以及手术和非手术结果。
背景资料概要
尽管 DS 和 SPS 患者的基础病理和治疗方法存在差异，但它们通常在临床研究中合并在一起。
方法
DS 队列包括 601 名患者（369 名[61%]接受了手术），SPS 队列包括 634 名患者（394 名[62%]接受了手术）。比较两组之间的基线特征。使用纵向回归模型比较两组患者在 1 年和 2 年时手术和非手术结果的变化。主要观察指标包括 SF-36 身体疼痛和身体功能评分以及 Oswestry 残疾指数。
结果
与 SPS 患者相比，DS 患者中女性更多（69%对 39%，P < 0.001），年龄更大（66.1 岁对 64.6 岁，P = 0.021），且多节段狭窄的可能性较小（35%对 61%，P < 0.001）。两组患者在任何主要结局指标上均无明显基线差异。接受手术的 DS 患者比 SPS 患者更有可能接受融合治疗（94%对 11%，P < 0.001），并且在所有主要结局指标上，手术对 DS 患者的改善均优于 SPS 患者（DS 对 SPS）：身体功能（+30.4 对 +25.3，P = 0.004 于 1 年；+ 28.3 对 +21.4，P < 0.001 于 2 年），身体疼痛（+32.3 对 +27.5，P = 0.006 于 1 年；+31.1 对 +26.1，P = 0.003 于 2 年），Oswestry 残疾指数（-25.9 对 -21.0，P < 0.001 于 1 年；-24.7 对 -20.2，P < 0.001 于 2 年）。接受非手术治疗的患者改善程度低于接受手术治疗的患者，两组患者在非手术治疗结果方面无显著差异。
结论
总体而言，DS 和 SPS 患者的基线特征相似。然而，DS 患者的手术治疗效果优于 SPS 患者。未来的研究可能不应该将这些异质患者群体合并在一起。
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