选择性经椎间孔椎体间融合术治疗腰椎退变性侧凸  

Treatment of degenerative lumbar scoliosis with selective segmental transforaminal lumbar interbody fusion

作　　者：王雷[1] 柳超[1] 赵庆华[1] 田纪伟[1] 

机构地区：[1]上海交通大学附属第一人民医院骨科,200080

出　　处：《中华医学杂志》2013年第23期1841-1844,共4页National Medical Journal of China

摘　　要：目的探讨后路椎弓根螺钉矫形结合选择性经椎间孔椎体间融合术（TLIF）治疗退行性腰椎侧凸的有效性。方法选择2008年11月至2012年3月上海交通大学附属第一人民医院骨科腰椎退变性侧凸症，患者42例，男14例，女28例；年龄41～76岁，平均62．4岁。节段行TLIF的标准：运动节段存在前后或侧方明显移位、节段不稳定，冠状位L3或L4椎体明显倾斜；3个节段行TLIF3例，2个节段17例，1个节段22例。随访6个月～3年，平均1．6年。影像学评价包括腰椎侧凸Cobb角、腰椎前凸角；临床疗效评价ODI评分。结果Cobb角术前平均（32．7±12．4）°，末次随访平均（9．2±5．5）°，与术前比较差异有统计学意义（t=14．86，P〈0．05），术后改善率71．8％。腰椎前凸角术前平均（25．5±12．6）°，末次随访平均（39．3±8．5）°，与术前比较差异有统计学意义（t=12．1l，P〈0．05），术后改善率46．4％。术前ODI评分（43．8±5．6）分，术后ODI评分（18．7±1．8）分，术前术后ODI评分差异有统计学意义（t=19．25，P〈0．05），末次随访ODI评分（23．6±2．3）分，疗效下降无显著性（P〉0．05）。86％患者下肢神经源性间歇性跛行缓解，92％患者自诉生活质量明显提高。6个月后复查X线片，腰椎融合节段达到骨性愈合，无假关节形成。结论选择性TLIF的应用有利于进一步恢复腰椎前凸、矫正节段畸形和移位，从而提高脊柱后路融合术治疗退行性腰椎侧凸的临床疗效。Objective To explore the treatment outcomes of degenerative lumbar scoliosis （DLS） with selective segmental transforaminal lumbar interbody fusion （TLIF）. Methods The clinical data were analyzed for a total of 42 cases with degenerative scoliosis from November 2008 to March 2011. There were 14 males and 28 females with a mean age of 62.4 years （ range, 41 - 76）. The indications for TLIF of motion segment included segmental instability and significant upper endplate obliquities of 13 or IA. Interbody spinal fusion was performed for 3 segments in 3 cases ; 2 in 17 ; 1 in 22. All patients were followed postoperatively with a mean duration of 1.6 years （ range, 0. 5 - 3 ）. The imaging examinations included Cobb angle of scoliosis and lumbar lordosis angle. The clinical symptoms were evaluated with Oswestry disability index （ODI） score. Results The mean preoperative Cobb angle of 32.7° ± 12.4° was significantly corrected to 9.2° ±5.5° at the final follow-up （t = 14. 86, P 〈 0. 05） with a correction rate of 71.8%. The mean preoperative lumbar lordosis angle of 25.5°± 12. 6° was also significantly corrected to 39. 3° ± 8. 5°（t = 12. 11, P 〈 0. 05 ） with a correction rate of 46.4%. There was significant difference （ P 〈 0. 05 ） in ODI between preoperation （43.8± 5.6） and postoperation （ 18.7 ±1.8 ）. But no significant difference （ P 〉 0. 05） existed in ODI between postoperation （ 18.7 ±1.8） and the final follow-up （23.6 ±2. 3）. And 86% of the patients showed considerable symptomatic improvement of neurogenic intermittent claudication. And clinical symptoms and functional tolerance for daily activities improved postoperatively in 92%. At the follow-up after 6 months postoperatively, all operated segments achieved fusion standard and no pseudoarthrosis formed. Conclusion Selective segmental TLIF is helpful in correcting lumbar lordosis, segmental deformity and translation. And it offers better outcomes of posterior spinal fusion for the treatment o

关 键 词：脊柱侧凸 脊柱融合术 腰椎 

分 类 号：R687[医药卫生—骨科学]