经后路减压植骨融合内固定术治疗腰椎退变性侧凸症  

Treatment of degenerative lumbar scoliosis via posterior decompression and fusion with internal fixation

作　　者：谢跃[1] 徐用亿[1] 王守国[1] 季峰[1] 费昊东[1] 赵庆华[2] 田纪伟[2] 

机构地区：[1]南京医科大学附属淮安第一医院骨科,223300 [2]上海交通大学附属第一人民医院脊柱外科

出　　处：《中华医学杂志》2011年第41期2931-2934,共4页National Medical Journal of China

摘　　要：目的探讨腰椎退变性侧凸症的发病机制、手术方法和临床疗效。方法回顾性分析自2007年1月至2010年3月期间行腰椎后路减压植骨融合内固定术治疗的32例腰椎退变性侧凸症患者，其中男14例，女18例，年龄为52～79岁，平均67．4岁。通过比较术前、术后Oswestry功能障碍指数（ODI）、Cobb’s角和腰椎前凸角变化来评价手术疗效。结果32例均获得12～50个月的随访，平均随访28．5个月，所有患者均在6个月后获得骨性融合，椎弓根螺钉位置良好，无断钉断棒，无假关节形成现象。术前ODI为（60±11）％，术后末次随访时为（21±6）％；术前Cobb’S角数为（28±9）°，术后末次随访时为（13±5）°；术前腰椎前凸角为（20±10）°，术后末次随访时为（41±12）°，差异均有统计学意义（均P〈0．05）。结论腰椎退变性侧凸症手术治疗应采取个体化设计，必须减压得当同时恢复重建腰椎冠状面和矢状面平衡，才能缓解患者的腰腿痛症状，提高生活质量。Objective To explore the pathogenic mechanism, operative techniques and therapeutic efficacy of lumbar degenerative seoliosis. Methods A retrospective analysis was performed for 32 patients （ 14 males and 18 females with a mean age of 67. 4 years old） with degenerative lumbar scoliosis undergoing posterior decompression and fusion with pedicle screw system from January 2007 to March 2010. The postoperative outcomes were radiologically evaluated with Oswestry disability index （ODI） , Cobb＇ angle and lumbar lordosis angle. Results All patients received a mean follow-up of 28.5 months （ range ： 12 - 50 ）. All lumbar joints achieved bony fusion at Month 6 post-operation. No complications occurred due to instrumentation. There was no pseudoarthrosis. The significant differences of ODI existed between preoperation and post-operation[ （60 ± 11 ）% vs （21 ±6）%, P 〈0. 01 ], Cobb＇ angle[ （28 ± 9）° vs （ 13± 5）°, P 〈0.01] and lumbar lordosis angle[（41 ± 12）° vs （20 ± 10）°, P 〈0.01]. Conclusion Individualized operations should be performed for degenerative lumbar scoliosis patients. Proper lumbar decompression and the reconstruction of coronal and sagittal balances may relieve symptoms and improve the quality of life.

关 键 词：脊柱侧凸 腰椎 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]