退变性腰椎侧凸不同手术方式的适应证选择  

Indications of different surgical options for degenerative lumbar scoliosis

作　　者：王华东[1] 吴闻文[1] 李利[1] 郭继东[1] 张宇鹏[1] 侯树勋[1] 

机构地区：[1]解放军总医院第一附属医院脊柱外科,北京市骨科植入医疗器械工程技术研究中心,全军骨科研究所,北京100048

出　　处：《中国骨与关节杂志》2015年第3期172-175,共4页Chinese Journal of Bone and Joint

摘　　要：目的探讨退变性腰椎侧凸（degenerative lumbar scoliosis,DLS）不同手术治疗方式的适应证选择。方法 57例DLS患者,平均年龄59.3（51-78）岁,平均病程7.1（2-15）年。根据不同的临床表现及影像学检查,选择不同治疗方式：A组27例,行椎管双侧多节段开窗减压、椎弓根螺钉器械长节段固定矫形、横突间植骨融合;B组24例,行椎管双侧开窗减压、短节段椎弓根螺钉固定、椎间植骨融合;C组6例,行单纯椎管减压术。术后1-2周佩带腰背支具下床活动,支具佩带3-6个月。结果术后平均随访36.7（26-65）个月,侧凸Cobb’s角矫正率平均73%（59%-85%）;A组的手术时间和手术出血量分别为（150.0±25.2）min、（450.0±55.3）ml,大于B组的（92.0±7.5）min、（205.0±16.5）ml和C组的（52.0±5.5）min、（106.0±19.6）ml,差异有统计学意义（P〈0.05）,而术后视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（oswestry disability index,ODI）改善率3组间差异无统计学意义（P〉0.05）。结论根据DLS不同的手术适应证,选择对患者有利的术式是提高疗效的关键。Objective To study the surgical indications of different treatment options for degenerative lumbar scoliosis. Methods A total of 57 patients with degenerative lumbar scoliosis, whose mean age was 59.3 years old（ range： 51-78 years） and mean course was 7.1 years（ range： 2-15 years）, underwent different surgical treatment according to their different clinical and radiological manifestations. In group A, 27 patients received multilevel decompression and long segmental pedical screw fixation with correction and posterolateral fusion. Multilevel decompression and short segmental pedical screw fi xation with interbody fusion but without correction were performed on 24 patients in group B. In group C, only multilevel decompression was carried out in 6 patients. All the patients could ambulate at 1-2 weeks after the operation with brace which should be worn for 3-6 months. Results The mean follow-up time was 36.7 months（ range： 26-65 months）. The mean correction rate of Cobb＇s angle was 73%（ range： 59%-85%）. The operation time and blood loss were（ 150.0±25.2） min and（ 450.0±55.3） ml in group A, which were larger than（ 92.0±7.5） min and（ 205.0±16.5） ml in group B and（ 52.0±5.5） min and（ 106.0±19.6） ml in group C, and the differences between group A and B and group A and C were statistically signifi cant. Effective pain relief and functional improvement had been obtained in all the 3 groups, with no statistically signifi cant differences in lumbar pain Visual Analogue Scale（ VAS） and Oswestry disability index（ ODI）. Conclusions It is the key to choose the best treatment options according to different surgical indications in order to increase the clinical results in the treatment of degenerative lumbar scoliosis.

关 键 词：脊柱弯曲 脊柱侧凸 腰椎 外科手术 减压术 外科 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]