长节段与短节段固定融合治疗退变性腰椎侧凸的比较

目的探讨手术治疗腰椎退变性侧凸长节段固定融合与短节段固定融合的选择。方法37例腰椎退变性侧凸患者行后路减压矫形融合内固定术，长节段固定融合21例，短节段固定融合16例，应用VAS及ODI评分评价患者疼痛及功能，Cobb法测量侧凸角度及腰椎生理前凸角，站立位脊柱全长C7铅垂线测量矢状面及冠状面平衡，并记录两组患者手术时间、术中出血量、手术并发症。结果平均随访3.2年（2～6年），手术时间和出血量长节段固定融合组显著大于短节段固定融合组（P＜0.01）；短节段固定融合组和长节段固定融合组术前侧凸角分别为18.5°±3.7°和27.3°±6.2°，术后随访末期分别为9.7°±3.9°和8.7°±5.6°，长节段固定融合组改善率显著优于短节段固定融合组（P＜0.01）；术前腰椎前凸角分别为21.3°±11.3°和18.8°±10.7°，术后随访末期分别为31.5°±12.1°和32.6°±11.5°，两组矫正率无显著差异（P＝0.35）。术前冠状面失衡分别为（0.8±0.3）cm和（2.8±1.1）cm，术后末次随访分别为（0.4±0.2）cm和（0.9±0.6）cm，两组矫正率有显著统计学差异（P＜0.05）。术前矢状面失衡分别为（3.9±2.5）cm和（6.4±3.1）cm，术后末次随访分别为（2.5±2.3）cm和（3.6±2.5）cm，两组改善率无显著统计学差异（P＝0.32）。术前ODI评分为64.3±21.4和72.3±15.4，末次随访分别为47.6±26.6和49.8±17.1，两组改善无显著差别（P＝0.19）；下腰痛VAS评分术前分别为3.5±0.6和7.2±0.7，术后末次随访分别为2.5±0.5和3.5±1.3，长节段固定融合组改善优于短节段固定融合组（P＜0.01）；下肢痛VAS评分术前分别为8.0±1.3和7.3±1.7，术后末次随访分别为2.1±1.5和2.0±1.2，两组比较无显著统计学差异（P＝0.24）。结论长节段固定融合仅在恢复患者冠状面平衡及缓解下腰痛方面优于短节段固定融合，其明显延长了手术时间，增加术中出血量及手术并发症。因此，对存在中度及以上下腰痛，侧凸Cobb′s角≥30°的患者，手术耐受力较好时应选择行长节段固定融合，否则应选择短节段固定融合。

Short fusion versus long fusion for degenerative lumbar scoliosis

Objective To explore the selecton of short fusion versus long fusion for degenerative lumbar scoliosis.Methods 37 patients undergoing decompression and fusion with pedicle screw instrumentation were evaluated.The long fusion group included 21 patients and the short fusion group included 16 patients.The low back pain,the lower limbs pain and activity function were evaluated by VAS and ODI 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 3.2 years （2-6）for all patients.The blooding and surgery time of long fusion group was significantly more than that of short fusion group（P〈0.01）;Before surgery,the average Cobb angle was 18.5°±3.7°in the short fusion group and 27.3°±6.2°in the long fusion group.At the last follow up was 9.7°±3.9°and 8.7°±5.6°,respectively.The recovery rate of long fusion group was better than that of short fusion group （ P〈0.01 ） .The lumbar lordosis angles of the preoperative was 21.3°±11.3°and 18.8°±10.7°,and improved to 31.5°±12.1°and 32.6°±11.5°at the last follow-up.The correction rate of two groups had no significant difference （ P=0.35 ） .Coronal imbalance improved significantly in the long fusion group more than in the short fusion group （ P 〈0.05 ） .However , there was no difference in the correction of lumbar lordosis and sagittal imbalance between the two groups .The ODI score of the＆amp;nbsp;preoperative was 64.3 ±21.4 and 72.3 ±15.4 ,at the last follow up was 47.6 ±26.6 and 49.8 ±17.1 .The improve rate of two groups had no difference （ P=0.19 ） .The VAS score of the low back pain was improved from 3.5 ±0.6 to 2.5 ±0.5 in short fusion group and 7.2 ±0.7 to 3.5 ±1.3 in long fusion group .The recovery rate of long fusion group was better than that of short fusion group （ P〈0.01 ） .The VAS score of the lower limbs pain was improved from 8.0 ±1.3 to 2.1 ±1.5 in short fusion group and 7.3 ±1.7 to 2.0 ±1.2 in long fusion group .The improve rate of two groups had no difference （ P=0.24 ） .Conclusion Long segment fusion only proved better in the low back pain and correcting coronal imbalance than did short fusion .but it causes a higher complication rate and increased surgery time and blooding.So,for patients with moderate to severe low back pain ,Cobb angle≥30°and good tolerance to the operation,long fusion should be selected ,otherwise,short fusion should be selected .