单纯椎管减压术与椎管减压合并内固定融合术治疗退变性脊柱侧凸的前瞻性随机对照研究
发布时间：2018-07-21 14:52
【摘要】：[目的]采用前瞻性随机对照试验的方法比较单纯椎管减压术与椎管减压合并内固定融合术治疗退变性脊柱侧凸的短期疗效,为制定手术方案提供依据。[方法]2012年11月~2014年2月,对62例符合纳入标准的退变性脊柱侧凸患者进行前瞻性随机对照试验研究。将符合纳入标准的患者分别随机选入A组或B组,A组采用单纯椎管减压术治疗,减压方法为潜行减压。B组采用减压合并内固定融合术治疗。A组共30例(其中男6例,女24例),B组共32例(其中男8例,女24例)。记录两组患者临床及随访的数据资料,采用SPSS 17.0对数据进行统计学分析。[结果]术后随访15~24个月,平均19个月。两组术后3个月冠状面Cobb角平均值与术前比较,差异有统计学意义(P0.001);末次随访冠状面Cobb角与术后3个月比较,差异无统计学意义,两种手术末次随访与术后3个月比较Cobb角变化差异无统计学意义。A组术后Cobb角矫正率为(42±25)%;B组为(59±28)%,B组平均值高于A组,且差异有统计学意义(P0.001)。所有患者术后临床症状均逐渐缓解,两组患者术后3个月与术前比较,末次随访与术后3个月比较,ODI、VAS数值均逐渐减小,P值均0.001,差异有统计学意义。B组术中失血量、手术时间、住院天数、下床时间、并发症例数均高于A组,且差异有统计学意义。随访期间两种手术后患者的临床症状逐渐改善,Cobb角均无加重趋势。[结论]采用潜行减压的方法单纯椎管减压术和椎管减压合并内固定融合术均是治疗退变性脊柱侧凸安全有效的手术方法;但单纯椎管减压术创伤小、术中失血少、手术时间短、下床及住院时间短、并发症发生少,椎管减压合并内固定融合术有较高的Cobb角矫正率。采用潜行减压可以有效避免减压节段的不稳定,防止减压节段侧凸程度的进展;采用椎管减压合并内固定融合术可以保证充分减压,保护减压节段。
[Abstract]:[objective] to compare the short-term efficacy of simple decompression with internal fixation fusion in the treatment of degenerative scoliosis by prospective randomized controlled trial. [methods] A prospective randomized controlled trial was conducted in 62 patients with degenerative scoliosis from November 2012 to February 2014. The patients who met the inclusion criteria were randomly selected into group A or group B to be treated with simple spinal canal decompression. The decompression was performed in group B and decompression combined with internal fixation fusion was performed in 30 patients (6 males, 6 males), and 30 patients (6 males) were treated with decompression combined with internal fixation fusion. There were 32 cases in group B (8 males and 24 females). The clinical and follow-up data of the two groups were recorded. SPSS 17.0 was used to analyze the data. [results] postoperative follow-up ranged from 15 to 24 months (mean 19 months). The coronal Cobb angle was significantly different between the two groups at 3 months after operation (P0.001), but there was no significant difference in the coronal Cobb angle between the last follow-up group and the postoperative 3 months. There was no significant difference in Cobb angle between the last follow-up group and the third month after operation. The correction rate of Cobb angle in group A was (42 卤25) vs (59 卤28) in group B, and the difference was statistically significant (P0.001). The clinical symptoms of all the patients were gradually relieved after operation. Compared with the patients before operation, the VAS value of ODIV in the last follow-up and 3 months after operation decreased gradually (P = 0.001), the difference was statistically significant. There was significant difference in the amount of blood lost during operation and the time of operation in group B. The days of hospitalization, the time of getting out of bed and the number of complications in group A were higher than those in group A, and the difference was statistically significant. During the follow-up period, the clinical symptoms of the patients improved gradually after the two operations, and the Cobb angle showed no tendency of aggravation. [conclusion] simple decompression of spinal canal and fusion of internal fixation are safe and effective methods for the treatment of degenerative scoliosis, but simple decompression of spinal canal has less trauma and less blood loss during operation. The operation time is short, the time of getting out of bed and hospital stay is short, the complication is less, the vertebral canal decompression and internal fixation fusion has the higher Cobb angle correction rate. Using latent decompression can effectively avoid the instability of decompression segment and prevent the progression of decompression segmental scoliosis. Using spinal canal decompression combined with internal fixation fusion can ensure full decompression and protect decompression segment.
【作者单位】： 滨州医学院附属医院;解放军第88医院;山东滨州市人民医院;
【基金】：山东省医药卫生科技发展计划项目(编号:2013WS0300)
【分类号】：R687.3
本文编号：2135881
[Abstract]:[objective] to compare the short-term efficacy of simple decompression with internal fixation fusion in the treatment of degenerative scoliosis by prospective randomized controlled trial. [methods] A prospective randomized controlled trial was conducted in 62 patients with degenerative scoliosis from November 2012 to February 2014. The patients who met the inclusion criteria were randomly selected into group A or group B to be treated with simple spinal canal decompression. The decompression was performed in group B and decompression combined with internal fixation fusion was performed in 30 patients (6 males, 6 males), and 30 patients (6 males) were treated with decompression combined with internal fixation fusion. There were 32 cases in group B (8 males and 24 females). The clinical and follow-up data of the two groups were recorded. SPSS 17.0 was used to analyze the data. [results] postoperative follow-up ranged from 15 to 24 months (mean 19 months). The coronal Cobb angle was significantly different between the two groups at 3 months after operation (P0.001), but there was no significant difference in the coronal Cobb angle between the last follow-up group and the postoperative 3 months. There was no significant difference in Cobb angle between the last follow-up group and the third month after operation. The correction rate of Cobb angle in group A was (42 卤25) vs (59 卤28) in group B, and the difference was statistically significant (P0.001). The clinical symptoms of all the patients were gradually relieved after operation. Compared with the patients before operation, the VAS value of ODIV in the last follow-up and 3 months after operation decreased gradually (P = 0.001), the difference was statistically significant. There was significant difference in the amount of blood lost during operation and the time of operation in group B. The days of hospitalization, the time of getting out of bed and the number of complications in group A were higher than those in group A, and the difference was statistically significant. During the follow-up period, the clinical symptoms of the patients improved gradually after the two operations, and the Cobb angle showed no tendency of aggravation. [conclusion] simple decompression of spinal canal and fusion of internal fixation are safe and effective methods for the treatment of degenerative scoliosis, but simple decompression of spinal canal has less trauma and less blood loss during operation. The operation time is short, the time of getting out of bed and hospital stay is short, the complication is less, the vertebral canal decompression and internal fixation fusion has the higher Cobb angle correction rate. Using latent decompression can effectively avoid the instability of decompression segment and prevent the progression of decompression segmental scoliosis. Using spinal canal decompression combined with internal fixation fusion can ensure full decompression and protect decompression segment.
【作者单位】： 滨州医学院附属医院;解放军第88医院;山东滨州市人民医院;
【基金】：山东省医药卫生科技发展计划项目(编号:2013WS0300)
【分类号】：R687.3
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，本文编号：2135881
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