【摘要】：[目的]采用前瞻性隨機(jī)對(duì)照試驗(yàn)的方法比較單純椎管減壓術(shù)與椎管減壓合并內(nèi)固定融合術(shù)治療退變性脊柱側(cè)凸的短期療效,為制定手術(shù)方案提供依據(jù)。[方法]2012年11月~2014年2月,對(duì)62例符合納入標(biāo)準(zhǔn)的退變性脊柱側(cè)凸患者進(jìn)行前瞻性隨機(jī)對(duì)照試驗(yàn)研究。將符合納入標(biāo)準(zhǔn)的患者分別隨機(jī)選入A組或B組,A組采用單純椎管減壓術(shù)治療,減壓方法為潛行減壓。B組采用減壓合并內(nèi)固定融合術(shù)治療。A組共30例(其中男6例,女24例),B組共32例(其中男8例,女24例)。記錄兩組患者臨床及隨訪的數(shù)據(jù)資料,采用SPSS 17.0對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。[結(jié)果]術(shù)后隨訪15~24個(gè)月,平均19個(gè)月。兩組術(shù)后3個(gè)月冠狀面Cobb角平均值與術(shù)前比較,差異有統(tǒng)計(jì)學(xué)意義(P0.001);末次隨訪冠狀面Cobb角與術(shù)后3個(gè)月比較,差異無(wú)統(tǒng)計(jì)學(xué)意義,兩種手術(shù)末次隨訪與術(shù)后3個(gè)月比較Cobb角變化差異無(wú)統(tǒng)計(jì)學(xué)意義。A組術(shù)后Cobb角矯正率為(42±25)%;B組為(59±28)%,B組平均值高于A組,且差異有統(tǒng)計(jì)學(xué)意義(P0.001)。所有患者術(shù)后臨床癥狀均逐漸緩解,兩組患者術(shù)后3個(gè)月與術(shù)前比較,末次隨訪與術(shù)后3個(gè)月比較,ODI、VAS數(shù)值均逐漸減小,P值均0.001,差異有統(tǒng)計(jì)學(xué)意義。B組術(shù)中失血量、手術(shù)時(shí)間、住院天數(shù)、下床時(shí)間、并發(fā)癥例數(shù)均高于A組,且差異有統(tǒng)計(jì)學(xué)意義。隨訪期間兩種手術(shù)后患者的臨床癥狀逐漸改善,Cobb角均無(wú)加重趨勢(shì)。[結(jié)論]采用潛行減壓的方法單純椎管減壓術(shù)和椎管減壓合并內(nèi)固定融合術(shù)均是治療退變性脊柱側(cè)凸安全有效的手術(shù)方法;但單純椎管減壓術(shù)創(chuàng)傷小、術(shù)中失血少、手術(shù)時(shí)間短、下床及住院時(shí)間短、并發(fā)癥發(fā)生少,椎管減壓合并內(nèi)固定融合術(shù)有較高的Cobb角矯正率。采用潛行減壓可以有效避免減壓節(jié)段的不穩(wěn)定,防止減壓節(jié)段側(cè)凸程度的進(jìn)展;采用椎管減壓合并內(nèi)固定融合術(shù)可以保證充分減壓,保護(hù)減壓節(jié)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 鹵25) vs (59 鹵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.
【作者單位】： 濱州醫(yī)學(xué)院附屬醫(yī)院;解放軍第88醫(yī)院;山東濱州市人民醫(yī)院;
【基金】：山東省醫(yī)藥衛(wèi)生科技發(fā)展計(jì)劃項(xiàng)目(編號(hào):2013WS0300)
【分類號(hào)】：R687.3

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1 賴歡樂(lè);劉東光;陳理端;陳環(huán)球;;單純減壓與減壓后融合治療單純退變性腰椎管狹窄癥療效對(duì)比研究[J];嶺南現(xiàn)代臨床外科;2013年05期

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本文編號(hào)：2135881