经椎间孔内镜下减压与有限节段减压融合术治疗成人退行性脊柱侧凸的疗效对比

Comparison of efficacies between transforaminal endoscopic decompression and limited decompression and fusion in the treatment of adult degenerative scoliosis

中文关键词:  成人退行性脊柱侧凸  椎间孔狭窄  下肢神经根病  经椎间孔镜下减压术

英文关键词:Adult degenerative scoliosis  Foraminal stenosis  Lower limb radiculopathy  Transforaminal endoscopic decompression

中文摘要:

  【摘要】 目的：探讨应用经椎间孔内镜减压术与有限节段减压融合术治疗成人退行性脊柱侧凸（adult degenerative scoliosis，ADS）的临床及影像学疗效。方法：回顾性分析自2018年1月～2021年1月因ADS于本科室接受手术的53例患者，根据手术方式分为微创组（31例，接受经椎间孔内镜减压术）与融合组（22例，接受有限减压融合术），并对以下资料进行分析对比：人口统计学资料、术前Lenke-Silva分级，术前、出院前、术后6个月以及末次随访时的放射学参数（侧凸Cobb角、脊柱整体平衡、脊柱-骨盆参数），出院前、术后3个月、术后6个月以及末次随访时的临床疗效评估资料，并发症发生率及再手术率。结果：患者平均随访15.68±3.26个月，微创组患者平均年龄显著高于融合组（78.64±5.19岁 vs 64.95±4.31岁，P<0.05）；微创组患者以Lenke-Silva Ⅰ、Ⅱ级畸形为主，均为单侧神经症状；融合组患者以Lenke-Silva Ⅱ、Ⅲ级畸形为主，73%的患者为单侧神经症状。微创组术前侧凸Cobb角显著低于融合组（23.92°±9.06° vs 39.58°±13.12°，P<0.05）。两组患者术后腰痛、下肢放射痛，以及功能障碍均较术前显著改善，末次随访时微创组腰痛及功能障碍评分优于融合组（P<0.05）。两组在随访过程中均未观测到冠、矢状位失衡；末次随访时：微创组侧凸Cobb角进展1.51°，融合组矫形丢失1.82°。微创组手术时间、出血量、并发症发生率，以及再手术率均低于融合组（P<0.05）。结论：对于下肢神经症状明显但不合并僵硬性冠、矢状位失平衡的ADS，两种手术方式均可以显著减轻患者症状。短期随访结果显示，单纯内镜减压术后侧凸进展程度较小，在功能改善方面优于有限节段融合术。

英文摘要:

  【Abstract】 Objectives: To investigate the characteristics of clinical and imaging outcomes and their differences between transforaminal endoscopic decompression and limited decompression and fusion surgery in the treatment of adult degenerative scoliosis(ADS). Methods: From January 2018 to January 2021, 53 patients suffering from ADS who underwent surgery in our department were retrospectively analyzed, and they were divided into either minimally invasive surgery(MIS) group(31 patients, underwent transforaminal endoscopic decompression) or fusion group(22 patients, underwent limited decompression and fusion surgery). The following data were comparatively analyzed: the baseline characteristics, the preoperative Lenke-Silva level, the radiographical parameters(scoliotic Cobb angle, global spinal balance parameters, and spinopelvic parameters) that measured at preoperation, before discharge, at six months after surgery, and at the final follow-up, clinical outcomes that evaluated at preoperation, before discharge, three months after surgery, six months after surgery, and the final follow-up, the incidence of surgical complications, and the reoperation rate. Results: The mean follow-up period was 15.68±3.26 months. The mean age of the patients in the MIS group was significantly higher than that in the fusion group(78.64±5.19 years vs 64.95±4.31 years, P<0.05). In the MIS group, the majority of the patients were classified as Lenke-Silva Ⅰ and Ⅱ, and all the patients suffered from unilateral lower limb radiculopathy; In the fusion group, more patients were of Lenke-Silva Ⅱ and Ⅲ levels, and 73% of the patients suffered from unilateral lower limb radiculopathy. The preoperative scoliotic Cobb angle in the MIS group was significantly smaller than that in the fusion group(23.92°±9.06° vs 39.58°±13.12°, P<0.05). Postoperatively, both groups of patients showed significantly improvement in back pain, leg pain, and functional disability. At the final follow-up, the scores for back pain and functional disability showed preferably improvement in the MIS group than those in the fusion group(P<0.05). During the postoperative follow-up, no coronal or sagittal imbalance was observed in both groups; At the final follow-up: the mean scoliotic Cobb angle progressed 1.51° in the MIS group, while the correction of scoliosis reduced 1.82° in the fusion group. The operative time, intraoperative blood loss, incidence of complications, and the reoperation rate in the MIS group were significantly lower than those in the fusion group(P<0.05). Conclusions: For ADS patients without rigid imbalance, both surgical interventions are able to significantly improve clinical symptoms. The short-term follow-up outcomes reveal that the endoscopic decompression superiors in less scoliosis progression after operation and functional improvement than limited fusion surgery.