结合影像学检查选择治疗腰椎退变性侧凸症术式的探讨  

Selection of suitable procedure in the treatment of degenerative lumbar scoliosis based upon imagingstudies

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

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

出　　处：《中华医学杂志》2013年第5期362-365,共4页National Medical Journal of China

摘　　要：目的比较改良经椎间孔腰椎融合（TLIF）与传统腰椎后外侧融合（PLF）结合椎弓根螺钉系统固定术式治疗腰椎退变性侧凸症的疗效。方法2008年8月至2011年8月28例腰椎退变性侧凸症患者分成改良TLIF术式组14例、PLF术式组14例，其中男12例，女16例，年龄为54-79岁，平均66．2岁。记录两组术式的手术时间、出血量、腰痛VAS评分、ODI指数、Cobb’s角和腰椎前凸角等指标。结果28例患者均获得12-45个月的随访，平均随访25．9个月。改良TLIF组手术时间（192．0±44．7）min，出血量（718．0±197．2）ml，PLF组手术时间（163．0±39．0）min，出血量（546．0±226．6）ml。改良TLIF组末次随访时均获得骨性融合，传统PLF组有2例没有获得骨性融合，其中1例出现假关节现象。末次随访的两组各自腰痛VAS评分、ODI指数、Cobb’角都较术前减少（P〈0．05），两组的各自腰椎前凸角较术前增加（P〈0．05）。两组之间的末次随访与术前的腰痛VAS评分差值、腰椎前凸角差值的比较差异有统计学意义（P〈0．05），两组之间的末次随访与术前的ODI指数差值、Cobb’角差值的比较差异无统计学意义（P〉0．05）。结论采用改良TLIF结合椎弓根螺钉系统固定术式治疗腰椎退变侧凸症是一种可选的、安全有效的手术方式，临床疗效优于PLF结合椎弓根螺钉系统固定术式。Objective To compare the clinical efficacies of two different procedures in the treatment of degenerative lumbar scoliosis. Methods From August 2008 to August 2011, 28 patients of lumbar degenerative scoliosis were divided into one group （ n = 14 ） undergoing modified transforaminal lumbar interbody fusion （TLIF） instrumented surgery and another group （n = 14） undergoing posterolateral fusion （PLF） instrumented surgery. There were 12 males and 16 females with a mean age of 66. 2 years （range： 54 -79 ）. The operative durations and bleeding volumes of two groups were recorded. The post-operative efficacy was evaluated with VAS （ visual analogue scale ） for low back pain, ODI （ Oswestry disability index） , Cobb＇ angle and lumbar lordosis angle on plain film. Results The mean follow-up period was 25.9 months. The operative duration was 192. 0 ±44.7 min in modified TLIF group versus 163.0 ± 39. 0 rain in PLF group. The bleeding volume was 718.0 ± 197.2 ml in modified TLIF group versus 546. 0 ±226. 6 ml in PLF group. All operated lumbar intervertebrae achieved bony fusion in modified TLIF group by the last follow-up. Two cases had no bony fusion and there was one case of pseudarthrosis in PLF group. Significant differences existed between two groups in pre-operative and post-operative values of VAS, ODI, Cobb＇ s angle and lumbar lordosis angle （ P 〈 0. 05 ）. There were significant differences between two groups in the values of pre-operative and post-operative VAS and lumbar lordosis angle （ P 〈 0. 05 ） but not in the values of pre-operative and post-operative ODI and Cobb＇ s angle （P 〉 0.05 ）. Conclusion As an alternative, safe and effective procedure, modified TLIF instrumented is superior to PLF instrumented in the treatment of lumbar degenerative scoliosis.

关 键 词：脊柱侧凸 腰椎 脊柱融合术 

分 类 号：R681.57[医药卫生—骨科学]