Clinical Comparison of Selective versus Nonselective Decompression for Symptomatic Tandem Stenosis of the Cervical and Thoracic Spine: A Retrospective Cohort Study.
Clinical Comparison of Selective versus Nonselective Decompression for Symptomatic Tandem Stenosis of the Cervical and Thoracic Spine: A Retrospective Cohort Study.
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选择性与非选择性减压治疗颈椎和胸椎症状性串联狭窄的临床比较：一项回顾性队列研究
DOI：
10.1111/os.12889
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发表时间：
2021-04
影响因子：
2.1
通讯作者：
Chen BH
中科院分区：
文献类型：
--
作者：
Wang C;Wang QZ;Gao JH;Zhang L;Zhang L;Chen BH
本文的目的是揭示选择性和非选择性减压治疗症状性颈胸段椎管狭窄的临床差异。共有34名患者符合条件并纳入了这项研究。其中8例行选择性颈椎减压术(CD)，15例行选择性胸椎减压术(TD)，11例行CD+TD联合手术(CTD)。比较三组患者的年龄、性别、手术时间、术中出血量、术后住院时间、住院费用、术前日本上骨科协会(JOA)率、椎管占有率、脊髓高信号T2加权像(T2WI)、术前术后JOA评分。CD组手术时间较短(138.8 ± 36.1vs 229.7 ± 95.8vs 328.6 ± 94.8，min，P <； 0.001)，术中出血量(141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5，mL，P=0.004)，术后住院天数(4.6 ± 1.6vs 9.0 ± 0.001 vs 10.3 ± 6.6，P=0.008)。术前上JOA率(34.1 ± 5.6vs53.9 ± 8.4vs48.2 ± 15.2%，P=0.001)均低于TD组和CTD组。CTD组住院费用高于CD组和TD组(87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715，CNY，P <； 0.001)。不同组间颈管占位率差异无统计学意义(P> >； )，但TD组胸椎管占位率高于CD组(58.3 ± 14.7vs43.3 ± 12.3，P=0.035)。脊髓高信号T2WI所有阳性节段均减压。3组术前、术后6个 月和末次随访的JOA值比较，差异有统计学意义(P&gT； ，0.05)。类似地，三组间的关节活动度恢复率无显著差异(P&gT； )。选择性CD或TD单独治疗TSCT的临床疗效与非选择性CTD和联合CTD相似。在仔细评估临床和放射学表现、一般患者情况和社会经济因素后，应作出个体化的手术决定。有症状的颈椎和胸椎串联性狭窄(TSCTS)是罕见的。选择性减压术和非选择性减压术治疗TSCTS的临床结果尚未见报道。我们的回顾研究发现，选择性颈椎或胸椎减压术与非选择性颈胸椎联合减压术治疗TSCTS的临床疗效相似。
The aim of the present paper was to reveal the clinical differences between selective and nonselective decompression for symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS). A total of 34 patients were eligible and included in the study. Among them, 8 patients underwent selective cervical decompression (CD), 15 patients underwent selective thoracic decompression (TD), and 11 patients underwent combined CD and TD (CTD) surgery. Age, sex, operative time, intraoperative blood loss, postoperative hospital stay, inpatient expenditure, preoperative upper Japanese Orthopaedic Association (JOA) rate, canal occupation rate, high‐intensity T2‐weighted image (T2WI) of the spinal cord, and preoperative and postoperative JOA scores were compared among the three groups. The CD group had shorter operative time (138.8 ± 36.1 vs 229.7 ± 95.8 vs 328.6 ± 94.8, min, P < 0.001), less intraoperative blood loss (141.3 ± 116.7 vs 496.7 ± 361.8 vs 654.6 ± 320.5, mL, P = 0.004), and shorter postoperative hospital stay (4.6 ± 1.6 vs 9.0 ± 3.5 vs 10.3 ± 6.6, days, P = 0.008), as well as lower preoperative upper JOA rate (34.1 ± 5.6 vs 53.9 ± 8.4 vs 48.2 ± 15.2, %, P = 0.001) than the TD and CTD groups. The CTD group had higher inpatient expenditure than the CD and TD groups (87,850 ± 18,379 vs 55,100 ± 12,890 vs 55,772 ± 15,715, CNY, P < 0.001). The cervical canal occupation rates were similar among different groups (P > 0.05); however, the TD group showed a higher thoracic canal occupation rate than the CD group (58.3 ± 14.7 vs 43.3 ± 12.3, %, P = 0.035). All positive levels in high‐intensity T2WI of the spinal cord were decompressed. The preoperative JOA scores as well as the postoperative JOA scores at 6 months and at last follow‐up were comparable among the three groups (P > 0.05). Similarly, the JOA recovery rate showed no significant difference among the groups (P > 0.05). Selective CD or TD alone demonstrated similar clinical effectiveness to nonselective and combined CTD for TSCTS. Individualized surgical decision should be made after meticulous assessments of clinical and radiological manifestations, general patient condition, and socioeconomic factors. Symptomatic tandem stenosis of the cervical and thoracic spine (TSCTS) is rare. The clinical outcomes of selective and nonselective decompression for TSCTS have not been previously reported. Our retrospective study found that selective cervical or thoracic decompression alone demonstrated similar clinical effectiveness to nonselective and combined cervical and thoracic decompression for TSCTS.
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通讯作者：
PAPATHEODOROU, C