手术治疗退变性腰椎侧凸5年以上随访研究  

Analysis of the clinical outcomes of the over 5-year follow-up study of degenerative lumbar scoliosis treated with posterior decompression and instrumented fusion

作　　者：李宏[1] 李淳德[1] 邑晓东[1] 刘洪[1] 卢海霖[1] 王宇[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《北京大学学报（医学版）》2016年第2期250-256,共7页Journal of Peking University:Health Sciences

摘　　要：目的：评价手术治疗退变性腰椎侧凸的临床效果及再次手术的危险因素和疗效。方法：回顾性分析2003年6月至2008年6月在北京大学第一医院骨科诊断为退变性腰椎侧凸并接受椎管减压、腰椎内固定手术的47例患者的完整病例资料,应用日本骨科协会评分（Japanese Orthopedic Association,JOA）和视觉模拟评分法（visual analogue score,VAS）评价其术后临床症状改善情况,并记录患者的再次手术原因和术后效果。结果：所有患者均完成随访,平均随访时间为（8.2±3.6）年（5.2-12.5年）,平均年龄（67.0±9.6）岁（56-81岁）。随访过程中有10例行再次翻修手术,其中固定节段近端失败8例、远端失败2例。37例首次手术后5年的平均临床改善优良率为83.3%,10例再次翻修术后1年平均临床改善优良率为67.6%。结论：手术治疗退变性腰椎侧凸随访5年以上具有较好的临床效果,但存在一定比例的再手术率,再次翻修手术的临床效果有所下降,患者低骨量、近端融合至L1及远端融合至S1可能是导致再次手术的危险因素。Objective： To evaluate the over 5-year follow-up clinical outcomes of degenerative lumbar scoliosis treated with operation of decompression and fusion,and the effectiveness and risks factors about revision surgery cases. Methods： A total of 47 cases of diagnosis of degenerative lumbar scoliosis treated with posterior decompression and instrument fusion recorded from Jun. 2003 to Jun. 2008 were analyzed.Lumbar Japanese Orthopedic Association（ JOA） score and visual analogue score（ VAS） were applied to evaluate the improvement of the clinical effect after surgery treatment,and the clinical effect and reasons of revising operation were recorded and analyzed. Results： All the 47 patients had finished the over 5-year followed-up time with an average time of（ 8. 2 ± 3. 6） years（ range from 5. 2 years to 12. 5 years）.The patient＇s mean age was（ 67. 0 ± 9. 6） years and the age of patient range from 56 years to 81 years.There were 10 patients who underwent revision surgery since primary operation,in whom 8 cases because of proximal failure of internal fixation and the other 2 cases because of distal failure of fusion segment.The average clinical improvement excellent rate was 83. 3% after 5 years since primary operation of 37 cases while the average fine rate of revision operation was 67. 6%. Conclusion： In the over 5-year follow-up,there was a better clinical outcome of degenerative lumbar scoliosis treated with posterior decompression and instrumented fusion,which had a certain rate of revision operation and had a worse effect of clinical results compared with primary operation. The risks of revision surgery included the poor bone quality of patients,with fusion to L1 at proximal terminal and the fusion end to S1 at distal terminal.

关 键 词：脊柱侧凸 腰椎 椎间盘退行性变 外科手术 治疗结果 

分 类 号：R682.3[医药卫生—骨科学]