退行性腰椎管狭窄症患者手术或非手术治疗的长期结果：一项前瞻性多中心研究。
Long-term Results After Surgical or Nonsurgical Treatment in Patients With Degenerative Lumbar Spinal Stenosis: A Prospective Multicenter Study.
机构信息
Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
Department of Physical Medicine and Rheumatology, Balgrist University Hospital, Zurich, Switzerland.
出版信息
Spine (Phila Pa 1976). 2020 Aug 1;45(15):1030-1038. doi: 10.1097/BRS.0000000000003457.
STUDY DESIGN
Prospective, multicenter cohort study.
OBJECTIVE
The aim of our study was to assess the course of patients over a period of 3 years undergoing surgical or nonsurgical treatments for degenerative lumbar spinal stenoses (DLSS) based on data from the Lumbar Stenosis Outcome Study (LSOS), prospectively performed in eight hospitals.
SUMMARY OF BACKGROUND DATA
The optimal treatment strategy for patients with DLSS is still debated.
METHODS
The outcomes of patients with verified DLSS were quantified by Spinal Stenosis Measure (SSM) symptoms- and SSM function-scores, and EQ-5D-3L (quality of life) summary index (SI) over time (up to 36-month follow-up), and minimal clinically important difference (MCID) in SSM symptoms, SSM function, and EQ-5D-3L SI from baseline to 36-month follow-up.
RESULTS
For this study, 601 patients met the inclusion criteria; 430 underwent surgery, 18 of them only after more than a year after enrolment, 171 received nonsurgical treatment only. At baseline, patients in the surgical and nonsurgical groups had similar values for the SSM symptoms and SSM function scores, but patients in the surgical group suffered significantly more from buttocks pain and reported more worsening symptoms over the last 3 months before enrollment in the study. Surgically treated patients (except changers) performed significantly better in all clinical outcome measures (P < 0.001) with a plateau at 12-month follow-up staying constant until the follow-up ended. Further, two-thirds of patients in the surgical group had a relevant improvement in function, symptoms, and quality of life, compared with only about half of those in terms of symptoms and even less in terms of function and quality of life with nonsurgical treatment.
CONCLUSIONS
Surgical treatment of DLSS results in more favorable clinical outcomes with a sustained effect over time, compared to nonsurgical treatment.
LEVEL OF EVIDENCE
研究设计
前瞻性、多中心队列研究。
目的
我们的研究旨在根据在 8 家医院进行的前瞻性腰椎管狭窄症结局研究（LSOS）的数据，评估接受手术或非手术治疗的退行性腰椎管狭窄症（DLSS）患者在 3 年内的病程。
背景资料概要
DLSS 患者的最佳治疗策略仍存在争议。
方法
通过脊柱狭窄测量（SSM）症状和 SSM 功能评分，以及 EQ-5D-3L（生活质量）总指数（SI），对经证实患有 DLSS 的患者的结局进行量化，时间为（最长 36 个月的随访），并从基线到 36 个月随访时 SSM 症状、SSM 功能和 EQ-5D-3L SI 的最小临床重要差异（MCID）。
结果
这项研究共纳入 601 例患者，其中 430 例接受了手术治疗，其中 18 例是在入组 1 年后才进行手术，171 例仅接受了非手术治疗。在基线时，手术组和非手术组患者的 SSM 症状和 SSM 功能评分相似，但手术组患者的臀部疼痛明显更严重，并且在研究入组前的最后 3 个月报告症状恶化的比例更高。除转换者外，接受手术治疗的患者（除转换者外）在所有临床结局测量中表现均明显更好（P < 0.001），且在 12 个月随访时达到平台期，直到随访结束。此外，与非手术治疗相比，手术组有三分之二的患者在功能、症状和生活质量方面有显著改善，而只有一半左右的患者在症状方面有改善，在功能和生活质量方面甚至更少。
结论
与非手术治疗相比，手术治疗 DLSS 可获得更有利的临床结局，并具有持续的效果。
证据等级
3。
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