NEJM:单纯腰椎管减压vs器械融合减压治疗退行性腰椎滑脱

2021-08-14 MedSci原创 MedSci原创

对于症状持续时间长,准备接受手术治疗的退行性腰椎滑脱患者,单纯腰椎管减压术的2年预后效果与内固定融合减压相当,但单纯减压组的再手术风险较高。

退行性脊椎滑脱是由于长期的椎间盘、关节突关节、以及周围韧带的退变、松弛而导致的椎间关节出现不稳定,表现为上位脊椎向前、向后或向侧方发生滑移,患者通常年龄大于60岁,临床表现为腿部和背部疼痛和功能受限。保守治疗无效后,患者往往需接受手术,除腰椎管减压外,联合器械融合(使用螺钉、棒、钢板或其他设备来帮助实现椎体融合)已被广泛用于治疗腰椎滑脱,其临床应用比例在某些国家可在90%以上。近日研究人员考察了在腰椎管狭窄和退行性脊柱滑脱患者中,单纯腰椎管减压手术与内固定融合减压的疗效差异。

在这项公开、多中心、非劣效性试验中,有症状的,腰椎管狭窄患者参与,患者对保守治疗无反应且单级腰椎滑脱在3mm以上。患者随机接受单纯腰椎管减压手术(减压组)或带器械融合术的减压手术(融合组)。研究的主要终点为术后2年ODI得分至少减少30%以上,非劣性边界为15%。次要终点为ODI得分平均变化、腿部和背部疼痛,手术和住院时间以及2年内的再手术。

患者平均年龄66岁,75%的患者有1年以上的腿部疼痛史,80%的患者有1年以上的腰背部疼痛史。减压组术后2年ODI得分较基线下降20.6分。融合组下降21.3分,平均差异为0.7分。治疗意向分析中,133名减压组患者中95人(71.4%)ODI得分至少减少30%,129名融合组患者中有94人(72.9%),达到非劣性终点。协议分析中,减压组和融合组ODI得分至少减少30%的患者比例均为75.5%,达到非劣性终点。各个次要终点与主要终点结果相近。2年后成像显示,100名接受融合的患者中,成功融合率为86%。减压组再手术率为12.5%,融合组为9.1%。

研究认为,对于症状持续时间长,准备接受手术治疗的退行性腰椎滑脱患者,单纯腰椎管减压术的2年预后效果与内固定融合减压相当,但单纯减压组的再手术风险较高

原始出处:

Ivar M. Austevoll et al. Decompression with or without Fusion in Degenerative Lumbar Spondylolisthesis . N Engl J Med,August 5,2021.

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1724274, encodeId=b3e91e2427492, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Wed Jun 29 21:03:01 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272155, encodeId=ec0612e2155c0, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525579, encodeId=1fcd15255e9a6, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589519, encodeId=8d341589519af, content=<a href='/topic/show?id=b7158545353' target=_blank style='color:#2F92EE;'>#腰椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85453, encryptionId=b7158545353, topicName=腰椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4ba17737329, createdName=cnxcy, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035728, encodeId=71321035e2831, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 14 14:03:01 CST 2021, time=2021-08-14, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1724274, encodeId=b3e91e2427492, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Wed Jun 29 21:03:01 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272155, encodeId=ec0612e2155c0, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525579, encodeId=1fcd15255e9a6, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589519, encodeId=8d341589519af, content=<a href='/topic/show?id=b7158545353' target=_blank style='color:#2F92EE;'>#腰椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85453, encryptionId=b7158545353, topicName=腰椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4ba17737329, createdName=cnxcy, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035728, encodeId=71321035e2831, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 14 14:03:01 CST 2021, time=2021-08-14, status=1, ipAttribution=)]
    2021-08-16 licz0427
  4. [GetPortalCommentsPageByObjectIdResponse(id=1724274, encodeId=b3e91e2427492, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Wed Jun 29 21:03:01 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272155, encodeId=ec0612e2155c0, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525579, encodeId=1fcd15255e9a6, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589519, encodeId=8d341589519af, content=<a href='/topic/show?id=b7158545353' target=_blank style='color:#2F92EE;'>#腰椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85453, encryptionId=b7158545353, topicName=腰椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4ba17737329, createdName=cnxcy, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035728, encodeId=71321035e2831, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 14 14:03:01 CST 2021, time=2021-08-14, status=1, ipAttribution=)]
    2021-08-16 cnxcy
  5. [GetPortalCommentsPageByObjectIdResponse(id=1724274, encodeId=b3e91e2427492, content=<a href='/topic/show?id=71c1628e901' target=_blank style='color:#2F92EE;'>#椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=62879, encryptionId=71c1628e901, topicName=椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d4e33593434, createdName=caobinglei8090, createdTime=Wed Jun 29 21:03:01 CST 2022, time=2022-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1272155, encodeId=ec0612e2155c0, content=<a href='/topic/show?id=cd1a854340b' target=_blank style='color:#2F92EE;'>#腰椎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85434, encryptionId=cd1a854340b, topicName=腰椎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e93e105, createdName=anminleiryan, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1525579, encodeId=1fcd15255e9a6, content=<a href='/topic/show?id=08548885835' target=_blank style='color:#2F92EE;'>#融合#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88858, encryptionId=08548885835, topicName=融合)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=08a911636812, createdName=licz0427, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1589519, encodeId=8d341589519af, content=<a href='/topic/show?id=b7158545353' target=_blank style='color:#2F92EE;'>#腰椎管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85453, encryptionId=b7158545353, topicName=腰椎管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c4ba17737329, createdName=cnxcy, createdTime=Mon Aug 16 02:03:01 CST 2021, time=2021-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035728, encodeId=71321035e2831, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Aug 14 14:03:01 CST 2021, time=2021-08-14, status=1, ipAttribution=)]
    2021-08-14 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0