Li Yuanqiang, Ou Yunsheng, Zhu Yong, Zhao Zenghui, Luo Wei, Xu Shuai, Yu Haoyang
Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Mar 15;34(3):285-293. doi: 10.7507/1002-1892.201905105.
To compare the effectiveness of decompression and short fusion or long fusion for degenerative scoliosis (DS) with a Cobb angle of 20-40° combined with spinal stenosis.
The clinical data of 50 patients with DS who were treated with decompression combined with short fusion or long fusion between January 2015 and May 2017 were retrospectively analysed. Patients were divided into long fusion group (fixed segments>3, 23 cases) and short fusion group (fixed segments≤3, 27 cases). There was no significant difference in gender, age, disease duration, and preoperative visual analogue scale (VAS) score of leg pain, Oswestry disability index (ODI), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), pelvic incidence (PI), pelvic title (PT), and sacral slope (SS) between the two groups ( >0.05); however, the VAS score of low back pain, Cobb angle, and sagittal vertical axis (SVA) in long fusion group were significantly higher than those in short fusion group ( <0.05), and the lumbar lordosis (LL) was significantly lower than that in short fusion group ( =2.427, =0.019). The operation time, intraoperative blood loss, fluoroscopy times, hospital stay, and complications were recorded and compared. The VAS scores of low back pain and leg pain and ODI score were used to evaluate the clinical outcomes before operation and at last follow-up. X-ray films of the whole spine in standard standing position were taken before operation, at 6 months after operation, and at last follow-up, and the spino-pelvic parameters were measured.
The operation time, intraoperative blood loss, and fluoroscopy times in the short fusion group were significantly less than those in the long fusion group ( <0.05); there was no significant difference in hospital stay between the two groups ( =0.933, =0.355). The patients were followed up 12-46 months with an average of 22.3 months. At last follow-up, the VAS scores of low back pain and leg pain and ODI score significantly improved when compared with those before operation ( <0.05). Except for the improvement of VAS score of low back pain ( =8.332, =0.000), the differences of the improvements of the other scores between the two groups were not significant ( >0.05). The Cobb angle, SVA, TLK, and PT significantly decreased, while SS and LL significantly increased in the long fusion group ( <0.05), while the Cobb angle and PT significantly decreased and SS significantly increased in the short fusion group at last follow-up ( <0.05). There was no significant difference in spino-pelvic parameters between the two groups at 6 months after operation and at last follow-up ( >0.05). The improvements of Cobb angle, SVA, LL, PT, and SS in the long fusion group were significantly higher than those in the short fusion group at last follow-up ( <0.05). There was no perioperative death in both groups. The incidence of complications in the long fusion group was 34.8% (8/23), which was significantly higher than that in the short fusion group [11.1% (3/27)] ( =4.056, =0.034).
The DS patients with the Cobb angle of 20-40°can achieve satisfactory clinical outcomes and improve the spino-pelvic parameters by choosing appropriate fixation levels. Short fusion has less surgical trauma and fewer complications, whereas long fusion has more advantages in enhancing spino-pelvic parameters and relieving low back pain.
比较减压联合短节段融合或长节段融合治疗Cobb角为20 - 40°并伴有椎管狭窄的退变性脊柱侧凸（DS）的疗效。
回顾性分析2015年1月至2017年5月间50例行减压联合短节段融合或长节段融合治疗的DS患者的临床资料。患者分为长节段融合组（固定节段>3，23例）和短节段融合组（固定节段≤3，27例）。两组患者在性别、年龄、病程、术前腿痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、胸椎后凸（TK）、胸腰段后凸（TLK）、骨盆入射角（PI）、骨盆倾斜角（PT）和骶骨倾斜角（SS）方面差异无统计学意义（>0.05）；然而，长节段融合组的腰痛VAS评分、Cobb角和矢状垂直轴（SVA）显著高于短节段融合组（<0.05），腰椎前凸（LL）显著低于短节段融合组（=2.427，=0.019）。记录并比较手术时间、术中出血量、透视次数、住院时间及并发症情况。采用腰痛和腿痛VAS评分及ODI评分评估术前及末次随访时的临床疗效。于术前、术后6个月及末次随访时拍摄标准站立位全脊柱X线片，测量脊柱-骨盆参数。
短节段融合组的手术时间、术中出血量及透视次数显著少于长节段融合组（<0.05）；两组住院时间差异无统计学意义（=0.933，=0.355）。患者随访12 - 46个月，平均22.3个月。末次随访时，与术前相比，腰痛和腿痛VAS评分及ODI评分显著改善（<0.05）。除腰痛VAS评分改善差异有统计学意义（=8.332，=0.000）外，两组其他评分改善差异无统计学意义（>0.05）。长节段融合组末次随访时Cobb角、SVA、TLK和PT显著减小，而SS和LL显著增加（<0.05），短节段融合组末次随访时Cobb角和PT显著减小，SS显著增加（<0.05）。术后6个月及末次随访时两组脊柱-骨盆参数差异无统计学意义（>0.05）。长节段融合组末次随访时Cobb角、SVA、LL、PT和SS的改善程度显著高于短节段融合组（<0.05）。两组均无围手术期死亡。长节段融合组并发症发生率为34.8%（8/23），显著高于短节段融合组[11.1%（3/27）]（=4.056，=0.034）。
Cobb角为20 - 40°的DS患者通过选择合适的固定节段可获得满意的临床疗效并改善脊柱-骨盆参数。短节段融合手术创伤小、并发症少，而长节段融合在改善脊柱-骨盆参数和缓解腰痛方面优势更明显。
