同期或分期手术治疗颈腰综合征的疗效观察与比较

Comparison of outcomes in simultaneous or staged operation for treatment of tandem spinal stenosis

中文关键词:  颈腰综合征  同期手术  分期手术  临床疗效

英文关键词:Tandem spinal stenosis  Simultaneous operation  Staged operation  Clinical outcomes

中文摘要:

  【摘要】 目的：对比分析同期手术或分期手术治疗的颈腰综合征患者的临床特点和手术疗效，为治疗选择提供依据。方法：2011年1月～2016年12月，在我院脊柱外科手术治疗并完成随访的颈腰综合征患者共127例，男79例，女48例，年龄46~74岁，平均61.7±8.6岁。依手术顺序不同进行分组研究，86例患者一期行颈椎手术（A组），28例一期行腰椎手术（B组），13例同期行颈腰椎手术（C组），分别记录各组手术时间、出血量、住院天数、术后并发症等，并应用日本骨科协会（Japanese Orthopaedic Association，JOA）评分、颈椎功能障碍指数（neck disability index，NDI）、腰椎Oswestry功能障碍指数（Oswestry disability index，ODI）等评测指标对患者预后行随访研究。结果：所有患者平均随访31.1±5.7个月。A组患者一期行颈椎手术后，33例未行二期手术（A1组），53例行二期腰椎手术（A2组），再手术率61.63%，平均间隔5.32±2.10个月；B组患者一期行腰椎手术后，3例未行二期手术（B1组），25例行二期颈椎手术（B2组），再手术率89.29%，平均间隔3.84±1.75个月；二次手术率及间隔时间两组间差异均有统计学意义（P<0.05）。三组患者末次随访时颈椎JOA、腰椎JOA评分均较术前明显改善，颈椎NDI及腰椎ODI均较术前明显降低，差异均有统计学意义（P<0.05）。将C组同期手术患者同A2、B2组患者进行比较，三组在手术时间、出血量差异均无统计学意义（P=0.106，P=0.255），但同期手术患者的住院时间降低（P<0.001），并发症稍高但差异无统计学意义（P=0.855）。结论：同期或分期手术治疗颈腰综合征均能获得满意临床疗效；依据主要临床症状选择分期手术时，应优先重视颈椎病情治疗，一期解除颈脊髓压迫可以降低二次腰椎手术率；颈腰椎同期手术不增加手术时间、出血量，可减少住院时间，但须严格掌握适应证。

英文摘要:

  【Abstract】 Objectives: To retrospectively observe different staged operations and simultaneous surgery for patients with tandem spinal stenosis(TSS) and compare the clinical outcomes. The results would provide the evidence for surgical decision-making. Methods: From January 2011 to December 2016, 127 patients with TSS were enrolled in the current study. The average age of patients, including 79 males and 48 females, was 61.7±8.6 years old(range from 46-74 years old). The patients were divided into three groups according to the surgical procedure, including cervical decompression first(group A, n=86), lumbar decompression first(group B, n=28) and simultaneous decompression(group C, n=13). Operation time, amount of bleeding, hospitalization time and the postoperative complications were recorded and compared. Cervical Japanese Orthopaedic Association(JOA), lumbar JOA, neck disability index(NDI) and Oswestry disability index(ODI) scores were used to evaluate the functional status of patients at pre-operation, post-operation and final follow-up. Results: The patients were followed for average of 31.1±5.7 months. In group A, 33 patients did not need a second lumbar surgery(group A1), but 53(61.63%) patients received the second lumbar decompression(group A2) after an average interval of 5.32±2.10 months. In group B, 3 patients did not need a second cervical surgery(group B1), but 25(89.29%) patients received the second cervical decompression(group B2) after an average interval of 3.84±1.75 months. There were significant differences in the reoperation rate and interval time(P=0.006, P=0.002). In each group, the cervical and lumbar JOA scores increased, and the NDI and ODI improved at final follow-up comparing with the preoperative scores. There were no significant difference between the three groups in operation time and the amount of bleeding(P=0.106, P=0.255), but the hospitalization time in simultaneous group was significantly lower(P<0.001). The complications were higher in the simultaneous group, but with no significant difference(P=0.855). Conclusions: These results indicate that TSS can be effectively managed by either surgical intervention, simultaneous, or staged decompressions. The first-stage cervical decompression can significantly lower the need of the second lumbar surgery. Simultaneous operation does not increase operation time and bleeding, however decreases the hospitalization time. The surgical indications should be strictly controlled when simultaneous operation was performed.