Surgery and Physical Therapy Equivalent for Lumbar Spinal Stenosis手术和理疗对腰椎管狭窄疗效相当

A randomized trial in the US concluded that surgical decompression yielded similar effects to physical therapy (PT) among patients with lumbar spinal stenosis (LSS) who were surgical candidates. The study took place from November 2000 to September 2007. A total of 169 surgical candidates with LSS aged 50 years or older were randomly assigned (87 to surgery and 82 to PT), with 24-month follow-up completed by 74 and 73 participants in the surgery and PT groups, respectively. Mean improvement in physical function score for the surgery and PT groups was 22.4 and 19.2, respectively. Intention-to-treat analyses revealed no difference between groups. Sensitivity analyses using causal-effects methods to account for the high proportion of crossovers from PT to surgery (57%) showed no significant differences in physical function between groups. Since the study suggests that the long-term outcomes tend to be equivalent for surgery and PT yet short-term risks differ, patients and health care providers should engage in shared decision-making, patient preferences should weigh heavily in the decision of whether to have surgery. Source: http://annals.org/美国一项随机试验得出的结论是手术减压和理疗对有手术适应症的腰椎管狭窄患者疗效类似。这项2000年11月至2007年9月间的研究，共有169名年龄超过50岁，有手术适应症的腰椎管狭窄患者被随机分配（87名手术和82 名理疗），手术组和理疗组分别有74和73名参与者完成了24个月的随访。手术组和理疗组身体机能改善分数分别为22.4和19.2。意向性治疗分析显示组间无差异。采用因果效应的方法进行的敏感性分析以阐明高比例的从理疗组到手术组（57％）的交叉显示，组间的身体机能无显著差异。由于该研究表明，手术和理疗的长期疗效相当，而短期风险则不然，患者和医方应共同参与决策，病人的喜好应对决定是否手术发挥重要作用。来源：http://annals.org/