后路长、短节段固定结合有限减压治疗退变性腰椎侧凸的比较研究

目的　比较两种后路减压、矫形术式治疗退变性腰椎侧凸症的临床和影像学结果。 方法 回顾两种后路减压、内固定术式治疗46例退变性腰椎侧凸的临床和影像资料，A组：选择性责任节段有限减压、短节段固定（2.7±0.5）26例；B组：责任节段减压、长节段固定（5.8±1.7）20例。应用JOA、VAS评价腰腿痛和活动功能，用Cobb法测量腰椎侧凸角、前凸角；比较两组临床和影像学结果，手术时间、出血量和手术并发症。 结果 平均随访2.8年（2～6.5年），手术时间和出血量B组显著大于A组（Pt<0.001, Pb<0.001）；术前侧凸角分别为(22±4.6)°(A组)和(28±7.3)°(B组)，术后随访末期分别为(11±3.8)°(A组)和(12±5.9)°(B组)，B组改善率显著优于A组(P<0.001)；术前腰椎前凸角分别为(19±4.6)°(A组)和(18±7.3)°　(B组)，术后随访末期分别为(29±3.8)°(A组)和(32±5.9)°(B组)，两组矫正率无显著差别（P=0.17）。术前、随访末期JOA评分为14±3.6、23±4.7(A组)和13±3.8、21±5.9（B组），分别较术前显著改善（PA<0.001, 　PB<0.001），改善率两组无显著差别(P=0.24)；术前、随访末期VAS评分为8±0.16、3±0.07(A组)和8±1.8、4±　2.7（B组），分别较术前显著改善（PA<0.001, PB<0.001），两组改善率无显著差别(P=0.22)；并发症发生率B组显著大于A组（P<0.001）。 结论　长节段固定侧凸矫正率高于短节段固定，但两组矢状面矫正和临床症状改善率相似，长节段固定手术并发症多、术后腰椎活动功能差，应该谨慎选择。

Posterior limited spinal decompression associated with short and long segments fusion for treating degenerative lumbar scoliosis: a comparative study

Objective　To compare clinical and radiographic outcomes of patients with degenerative lumbar scoliosis, treated by two kinds of posterior surgery.　Methods　Clinical and radiographic outcomes of 46 patients with degenerative lumbar scoliosis, and treated by two kinds of posterior surgery, were analyzed retrospectively. short-segment fixation was taken as group A（2.7±0.6, n=26）, and long-segment fixation as group B（5.6±1.4, n=20）. The lumbocrural pain and activity function were evaluated by JOA and VAS scores. The Cobb's angles were measured to assess the lumbar scoliosis and kyphosis. The clinical and radiographic outcomes, including surgery time, blooding and surgery complications were compared between two groups.　Results　The mean follow-up was 2.8 years (2~6.5) for all patients. The blooding and surgery time of group A was significantly more than that of group B（Pt<0.001, Pb<0.001）；The scoliosis angles of pre-operative was 22±4.6°(group A) and 28±7.3°(group B) respectively, and 11±3.8°(group A) and 12±5.9°(group B) at the end of follow-up. The recovery rate of group A was better than that of group B(P<0.001). The lumbar lordosis angles of the preoperative was 19±4.6°(group A) and 18±7.3°(group B), and improved to 29±3.8°(group A) and 32±5.9°(group B) at final follow-up. The correction rate of two groups had no significant difference（P=0.17）. The JOA score of the preoperative and fellow-up was 14±3.6, 23±4.7(group A) and 13±3.8, 21±5.9（group B）respectively, and both improved after surgery. The improve rate of two groups have no difference（P=0.24）. The VAS score of the preoperative and fellow-up was 8±0.16, 3±0.07(group A) and 8±1.8, 4±2.7（group B）, and both improved after surgery. The improve rate of two groups had no difference（P=0.22）. The complication incidence of group B was significant higher than group A（P<0.001）.　Conclusion　Although the scoliosis correction rate of long-segment fixation group is higher, the lumbar lordosis correction rate and clinical outcome have no significant difference compared to short one. Furthermore, long-segment fixation causes a higher complication rate and worse lumbar functional activity after surgery.