退变性腰椎侧凸症的手术治疗策略  

Surgical management for degenerative lumbar scoliosis

作　　者：昌耘冰[1] 詹世强[1] 王义生[1] 柯雨洪[1] 刘斌[1] 王巧明[1] 曾时兴[1] 尹东[1] 肖丹[1] 

机构地区：[1]广东省人民医院骨科,广州510080

出　　处：《中国骨科临床与基础研究杂志》2013年第4期226-230,共5页Chinese Orthopaedic Journal of Clinical and Basic Research

摘　　要：目的探讨退变性腰椎侧凸症（DLS）个体化手术治疗方式的选择，观察其手术疗效。方法收集2007年12月至2010年12月广东省人民医院收治的27例经手术治疗并随访24个月以上的DLS病例。根据临床症状、体征和影像学检查，结合基础疾病评估，分别采用单纯减压，短节段减压、融合固定和多节段减压、矫形、融合固定的术式治疗。观察术后疼痛缓解和功能改善情况。结果27例患者获随访27~63个月，平均随访时间34．9个月。术后2年侧凸Cobb角为7．7°±0．7°。术前、术后视觉模拟量表（VAS）评分和Oswestry功能障碍指数（0DI）评分分别为（8．4±0．4）、（1．7士0．4）分和（70±4）、（19±4）分，两者比较，差异有统计学意义（P〈0．05）。按VAS评分疗效评定标准，优7例、良10例、中8例、差2例，优良率63％（17／27）；按ODI评分疗效评定标准，优11例、良12例，中2例、差2例，优良率85％（23／27）。1例严重骨质疏松者出现内固定松动；另有2例出现下肢肌力下降，随访至3个月左右均恢复。结论DLS治疗以缓解症状为主要目的，个性化选择手术适应证和术式是有效的外科治疗策略。Objective To investigate the individualized surgical treamaent of degenerative lumbar scoliosis （DLS）, and to evaluate the clinical outcomes of those different surgical techniques. Methods Twenty-seven DLS patients were treated surgically in Guangdong General Hospital from December 2007 to December 2010, and followed up over 24 months. According to clinical symptoms, signs and radiology examination, combined with the evaluation of fundamental diseases, three kinds of surgical procedures were performed including decompression only, decompression with short segmental fixation and fusion, as well as decompression with multilevel correction, fixation and fusion. Postoperative pain relief and function improvement of DLS patients were observed. Results All patients were followed up from 27 to 63 months, with the average of 34.9 months. Scoliotic Cobb angle at 2 years after the surgery was 7.7~ ~： 0.7. Preoperative and postoperative VAS score and ODI were 1.7 ~ 0.4, 8.4 4- 0.4 and 70 ~ 4, 19 ~ 4 respectively, the differences between preoperative and postoperative had statistical significance （P 〈0.05）. According to VAS criteria, there were excellent in 7 cases, good in 10 cases, fair in 8 cases and poor in 2 cases, the excellent and good rate was 63% （17/27）; According to ODt criteria, there were excellent in 11 cases, good in 12 cases, fair in 2 cases and poor in 2 cases, with the excellent and good rate was 85% （23/27）. One patient with serious osteoporosis had fixation loosening, and 2 patients suffered from muscle weakness, and then got complete recovery 3 months after the surgery. Conclusions More attentions should be paid on symptoms rather than deformities in the surgical treatment of DLS. Indications and surgical methods should be selected individually according to different patients.

关 键 词：腰椎 脊柱侧凸 退变性疾病 减压术 外科 脊柱融合术 内固定器 矫形外科手术 

分 类 号：R687.3[医药卫生—骨科学]