顶椎区凹侧椎间松解治疗退变性腰椎侧凸的临床疗效评价  

Clinical evaluation of intervertebral release on the concave side at the apex of the curve for the treatment of degenerative lumbar scoliosis

作　　者：马晓生[1,2] 姜建元[1,2] 吕飞舟[1,2] 马天文[1,2] 王洪立[1,2] 夏新雷[1,2] 王立勋[1,2] 

机构地区：[1]复旦大学附属华山医院骨科 [2]复旦大学脊柱外科中心,上海200040

出　　处：《中国骨与关节杂志》2015年第3期198-202,共5页Chinese Journal of Bone and Joint

基　　金：腰椎退变性疾病诊疗技术的优化选择与临床验证研究(12411951201)

摘　　要：目的探讨腰椎后路,经顶椎区凹侧进行椎体间松解及植入椎间融合器,结合后路小关节松解、长节段减压融合治疗退变性腰椎侧凸（degenerative lumbar scoliosis,DLS）的短期临床疗效。方法 2009年1月至2012年1月,我科经后路长节段矫形减压融合治疗22例退变性脊柱侧凸（degenerative scoliosis,DS）患者,随访时间平均18（6-24）个月,内容包括手术操作时间,术中失血量,手术相关并发症,术前、术后疼痛视觉模拟评分（visual analogue scale,VAS）和Oswestry功能障碍指数（oswestry disability index,ODI）,手术优良率,随访术后X线片冠状面及矢状面的矫正效果。结果术前Cobb’s角平均41.6°（31-56）°,术后Cobb’s角平均10.7°（0-15）°;该组患者术前VAS评分及ODI指数分别为（7.3±2.4）分、（60.5±7.6）%,术后随访分别为（1.7±1.4）分、（18.6±4.2）%,术后末次随访VAS评分及ODI指数较术前均有改善,差异有统计学意义（P〈0.05）,临床优良率达82.4%。随访期间无假关节形成,矫正度数及椎间隙高度无明显丢失,融合器无移位。结论后路顶椎区凹侧椎体间松解结合椎间融合器是治疗DS的一种安全有效的方法。Objective To study the short-term clinical results of posterior surgery for degenerative lumbar scoliosis, which consisted of posterior facet joint release, long segment fusion and intervertebral release followed by interbody cage implantation on the concave side at the apex of the curve. Methods From January 2009 to January 2012, 22 patients with degenerative lumbar scoliosiswere treated by posterior long segment fusion. The mean follow-up period was 18 months（ range： 6-24 months）. The operation time, intraoperative blood loss, postoperative complications, preoperative and postoperative Visual Analogue Scale（ VAS） and Oswestry disability index（ ODI） scores, excellent-good rate and correction results on the coronal and sagittal plane images were analyzed. Results Themean preoperative Cobb＇s angle was 41.6°（ range： 31°-56°）, and the mean postoperative Cobb＇s angle was 10.7°（ range： 0°-15°）. The preoperative VAS and ODI were（ 7.3±2.4） points and（ 60.5±7.6） %, which were improved to（ 1.7±1.4） points and（ 18.6±4.2） % after the surgery, and the differences were statistically signifi cant（ P〈0.05）.The clinical excellent and good rate was 82.4%. During the follow-up, there was no occurrence of pseudarthrosis, cage displacement, loss of correction angle or loss of intervertebral spcae height. Conclusions The combination of posterior intervertebral release and interbody cage implantation on the concave side at the apex of the curve is found to be an effective and safe method for degenerative lumbar scoliosis.

关 键 词：脊柱弯曲 脊柱侧凸 腰椎 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]