目的:成人退行性脊柱侧凸(ADS)的常用治疗方法为后路长节段螺钉内固定术和截骨术。最近,腰椎外侧椎间融合术联合两阶段后路螺钉固定(LLIFPSF)作为不截骨的新策略。在这里,这项研究旨在比较LLIF+PSF和椎弓根减影截骨术(PSO)的临床和放射学结果,后柱截骨术(PCO)。
方法:选择2013年1月至2018年1月在宁波第六医院接受手术随访2年的139例ADS患者作为研究对象。58例患者纳入PSO组,PCO组45例,LLIF+PSF组36例,从病历中审查临床和放射学数据。基线特征,围手术期放射学数据(矢状面垂直轴(SVA),日冕平衡(CB),Mian曲线的Cobb角(MC),腰椎前凸(LL),骨盆倾斜(PT)和骨盆发生率-腰椎前凸不匹配(PI-LL)),临床结果(背部和腿部的VAS,评估并比较Oswestry残疾指数(ODI)和脊柱侧弯研究学会22个问题问卷(SRS-22)和并发症。
结果:基线特征没有显着差异,三组的术前放射学参数和临床结局。LLIF+PSF组手术时间明显短于其他两组(P<0.05),而LLIF+PSF组住院时间显著延长(P<0.05)。至于放射学参数,LLIF+PSF组SVA有显著改善,CB,MC,LL和PI-LL(P<0.05)。此外,LLIF+PSF组在SVA中实现了明显更少的校正损失,CB和PT优于PSO和PCO组(1.5±0.7VS2.0±0.9VS2.2±0.8,P<0.05;1.0±0.4VS1.3±0.5VS1.1±0.7,P<0.05和4.2±2.8VS7.2±3.1VS6.0±2.8,P<0.05)。背部和腿部的VAS显著恢复,ODI评分和SRS-22在所有组中都有发现,然而,LLIF+PSF在随访时显示出明显优于其他两组(P<0.05)。两组并发症比较差异无统计学意义(P=0.66)。
结论:外侧腰椎椎间融合术联合二期后路螺钉固定(LLIF+PSF)可实现与截骨治疗成人退行性脊柱侧凸的临床治疗。然而,此外,未来还需要进行更多的研究来验证LLIF+PSF的效果。
OBJECTIVE: The commonly used treatments of adult degeneration scoliosis (ADS) were posterior long segment screw fixation with osteotomies. Recently, lateral lumbar intervertebral fusion combined two-stage posterior screw fixation (LLIF + PSF) as a new strategy without osteotomy. Herein, this
study aimed to compare the clinical and radiological outcomes among LLIF + PSF and pedicle subtraction osteotomy (PSO), posterior column osteotomies (PCO).
METHODS: Totals of 139 ADS patients underwent operation with 2 years longer follow-up visit between January 2013 and January 2018 in Ningbo No.6 Hospital were enrolled into this
study. 58 patients were included in PSO group, 45 in PCO group and 36 in LLIF + PSF group, The clinical and radiological data were reviewed from medical records. Baseline characteristic, perioperative radiological data (sagittal vertical axis (SVA), coronal balance (CB), Cobb angle of Mian curve (MC), Lumbar lordosis (LL), pelvic tilt (PT) and pelvic incidence-lumbar lordosis mismatch (PI-LL)), clinical outcomes (VAS of back and leg, Oswestry disability index (ODI) and Scoliosis Research Society 22-question Questionnaire (SRS-22)) and complications were evaluated and compared.
RESULTS: There were no significantly difference in baseline characteristics, preoperative radiological parameters and clinical outcomes among three groups. LLIF + PSF group was significantly shorter in operation time than other two groups (P < 0.05), whereas significant longer hospital stay was observed in LLIF + PSF group (P < 0.05). As for radiological parameters, LLIF + PSF group had significantly improvement in SVA, CB, MC, LL and PI-LL (P < 0.05). Moreover, LLIF + PSF group achieved significantly less correction loss in SVA, CB and PT than PSO and PCO group (1.5 ± 0.7 VS 2.0 ± 0.9 VS 2.2 ± 0.8, P < 0.05; 1.0 ± 0.4 VS 1.3 ± 0.5 VS 1.1 ± 0.7, P < 0.05 and 4.2 ± 2.8 VS 7.2 ± 3.1 VS 6.0 ± 2.8, P < 0.05). Significantly recovery in VAS of back and leg, ODI score and SRS-22 were found among all groups, however, LLIF + PSF shown significant better clinical therapy maintain at follow-up visit than other two groups (P < 0.05). There were no significantly difference in complications among groups (P = 0.66).
CONCLUSIONS: Lateral lumbar interbody fusion combined two-stage posterior screw fixation (LLIF + PSF) can achieve comparable clinical therapy for adult degeneration scoliosis as osteotomy strategies. However, furthermore more studies need be taken for verifying the effect of LLIF + PSF in the future.