摘要目的 探讨成人退变性脊柱侧凸( DS)后路减压长、短节段融合内固定术后中期临床效果.方法 回顾性分析黄山市人民医院脊柱外科2012年1月—2016年12月接受后路减压长、短节段融合内固定术的成人DS患者46例.根据融合节段长短不同分为两组:长节段组26例,男9例、女17例,年龄46~78岁;短节段20例,男7例、女13例,年龄50~76岁.比较两组患者年龄、性别、融合节段数、减压节段数、手术时间、出血量、术后住院时间;根据影像学资料比较两组手术前、术后1年及末次随访时腰椎侧凸Cobb’s角、腰椎前凸角及脊柱平衡改善情况,评价矫形效果;结合腰腿痛视觉模拟评分(VAS)、腰椎日本骨科协会(JOA)评分与Oswestry 功能障碍指数( ODI),评价两组患者手术前后生活质量改善情况.结果 46例患者随访1. 5~3. 3年,平均2. 2年.两组患者年龄、性别、减压节段数比较差异均无统计学意义(P值均>0. 05).两组患者在融合节段、出血量、手术时间和住院时间差异均有统计学意义(P值均<0. 05).两组患者Cobb’s角、腰椎前凸角的术前、术后1年、末次随访差异均无统计学意义(P值均>0. 05),术后1年、末次随访的Cobb’s角、腰椎前凸角、冠状面平衡、矢状面平衡均较术前得到明显改善(P值均<0. 05);长节段组的冠状面、矢状面平衡术前均优于短节段组(P值均<0. 05),术后1年及末次随访差异无统计学意义(P值均>0. 05).两组腰痛、腿痛VAS、腰椎JOA评分、ODI评分术后与术前比较差异均有统计学意义(P值均<0. 05),术后1年、末次随访中长节段组较短节段组均明显改善(P值均<0. 05).结论 采用长节段融合内固定术治疗DS较短节段融合内固定术可获得更好的中期临床疗效.

abstractsObjective To evaluate the mid-term outcome of the long and short segment fusion and internal fixation for adult degenerative scoliosis( DS). Methods Clinical data of 46 consecutive patients with degenerative scoliosis who were treated by posterior decompression and long segment or short segment instrumented fusion operation in People’s Hospital of Huangshan City from January 2012 to december 2016 were collected and retrospectively analyzed. The patients were divided into long and short segment fusion fixation group. There were 17 women and 9 men with a mean age of 55 years old(range 45 to 78 years) in long segment fixation group and 13 women and 7 men with a mean age of 60. 7 years old( range 45 to 82 years old) in short segment fixation group. Gender, age, fusion segments, operation time, segments of decompression, blood loss and the time of hospitalization were collected and compared. Radiologic parameters including the coronal Cobb’s angle,coronal and sagittal balance of spine were recorded for the assessment of correction. The visual analogue scales(VAS) scoring for low back pain and sciatica, Japanese Orthopaedic Association ( JOA) score, together with Oswestry disability index ( ODI ), were applied to evaluate the preoperative and postoperative quality of life. Results All the patients were followed up for average 2. 2 years ( 1. 5 to 3. 3 years old). There were no significant differences between the age, sex, decompression segment(all P values>0. 05). However there were significant differences between the fusion segments, blood loss, operation time and time of hospitalization ( all P values <0. 05). There was no significant difference between the two groups in the preoperative and postoperative follow-up of Cobb’s angle and lumbar lordosis (all P values >0. 05), and the coronal sagittal balance of Cobb’s angle and lumbar lordosis were significantly improved in the final follow-up of 1 year after surgery (all P values <0. 05). There were significant differences between the long and the short segment fixation group pre-operation in coronal balance and sagittal balance(all P values<0. 05) , and there was no statistical difference between the two groups 1 year after surgery and at the last follow-up (all P values>0. 05). There were significant differences between the pre-operation and post-operation in radiological parameters, VAS, JOA score, and ODI (all P values<0. 05) . There were significant differences between the long and short segment fixation group in VAS score, JOA and ODI in 1year after operation and the last follow-up (all P values<0. 05). Conclusions Compared with shorter-segment fusion, long-segment fusion and internal fixation can achieve better mid-term clinical outcomes.