腰椎后路楔形截骨术治疗重度脊柱侧后凸畸形的疗效分析及术后康复

目的分析腰椎后路楔形截骨术对重度脊柱侧后凸畸形的临床疗效及术后康复影响。方法选取80例重度脊柱侧后凸畸形病人作为研究对象，随机分为观察组和对照组，各40例。对照组实施经椎弓根椎体截骨治疗，观察组实施腰椎后路楔形截骨治疗及术后康复训练。观察2组术前、术后的Cobb角矫正、Oswestry功能障碍指数（ODI）、日常生活活动能力（ADL）评分、脊髓神经功能Frankle分级和并发症发生情况，以及手术时间、术中出血量、术后住院时间、平均固定节段数等临床手术指标资料。结果2组组内术前、术后Cobb角差异均有统计学意义（P < 0.01），术后Cobb角明显低于术前（P < 0.01）；但术前和术后2组间Cobb角差异均无统计学意义（P>0.05）。2组组内术前、术后ODI和ADL评分差异均有统计学意义（P < 0.01），2组间术后6个月、12个月的ODI和ADL评分差异均有统计学意义（P < 0.05~P < 0.01）。术前2组间Frankle分级差异无统计学意义（P>0.05），术后12个月2组间Frankle分级差异有统计学意义（P < 0.01）。观察组术中出血量和术后住院时间均明显低于对照组（P < 0.01），2组间手术时间和平均固定节段数差异均无统计学意义（P>0.05）。结论腰椎后路楔形截骨术创伤小，结合术后康复训练可改善病人腰椎功能和脊髓神经功能障碍，提高病人生活质量，值得临床推广应用。

Curative effect analysis and postoperative rehabilitation of lumbar posterior wedge osteotomy in the treatment of severe scoliosis deformity

ObjectiveTo analyze the clinical effects and rehabilitation strategy of posterior wedge osteotomy in the treatment of severe scoliosis deformity.MethodsEighty patients with severe scoliosis were selected and randomly divided into the observation group and control group(40 cases in each group).The observation group was treated with posterior lumbar wedge osteotomy combined with rehabilitation training, and the control group was treated with transpedicular vertebral osteotomy.The Cobb angle correction, Oswestry dysfunction index(ODI), activity of daily living(ADL)score, Frankle grade of spinal nerve function in two groups before and after operation were observed.The operation time, intraoperative bleeding volume, hospital stay after operation, average number of fixed segments and complications were compared between two groups.ResultsThe differences the Cobb angles in two groups between before and after operation were statistically significant(P < 0.01), the Cobb angle in two groups after operation were significantly lower than that before operation(P < 0.01), and the differences the Cobb angles between two groups before and after operation were not statistically significant(P>0.05).The differences the scores of ODI and ADL in two groups between before and after operation were statistically significant(P < 0.01), the differences the scores of ODI and ADL between two groups after 6 and 12 months of operation were statistically significant(P < 0.05 to P < 0.01).The difference of the Frankle grade between two groups before operation was not statistically significant(P>0.05), and the difference of the Frankle grade between two groups after 12 months of operation was statistically significant(P < 0.01).The intraoperative blood loss and postoperative hospital stay in observation group were significantly lower than those in control group(P < 0.01).There was no statistical significance in the operation time and the average number of fixed segments between two groups(P>0.05).ConclusionsThe posterior wedge osteotomy of lumbar spine has less trauma, and which combined with rehabilitation training after operation can improve the lumbar spine function, spinal nerve dysfunction and quality of life of patients, and is worthy of clinical promotion.