腰椎后路选择性减压融合治疗退变性脊柱侧凸的中期疗效  

Midium term effi cacy analysis of selective posterior decompression and fusion in treatment of adult degenerative scoliosis

作　　者：孟祥龙[1] 海涌[1] 康南[1] 刘玉增[1] 鲁世保[1] 苏庆军[1] 

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100039

出　　处：《脊柱外科杂志》2016年第2期70-74,共5页Journal of Spinal Surgery

基　　金：首都医科大学基础临床合作课题(14JL36)

摘　　要：目的探讨后路选择性减压、椎弓根螺钉内固定植骨融合治疗成人退变性脊柱侧凸的中期临床效果。方法2006年8月—2012年8月,本院收治38例成人退变性脊柱侧凸患者,其中男8例,女30例;年龄52-78岁,平均63.4岁。所有患者术前均行X线、CT和MRI检查。术前Cobb角为23.5°±8.5°;腰椎前凸角（LLA）21.4°±10.8°;C7铅垂线与S1椎体后上缘距离,即矢状位平衡（SVA）为（6.9±5.5）cm;C7铅垂线与骶正中线距离（CSVL）为（7.2±5.6）cm。所有患者采用后路有限减压、固定融合手术进行治疗。采用疼痛视觉模拟量表（VAS）、生活质量评价量表SF-36进行疗效评估。结果所有手术顺利完成,38例患者均获得随访,随访2.5-4.8年,平均4.2年。患者术后3个月及末次随访腰痛和腿痛VAS评分、Cobb角、LLA、SVA和CSVL均较术前明显改善,差异有统计学意义（P〈0.05）。按SF-36评分结果评价疗效,优22例、良12例、可2例、差2例,34例患者健康状况及生活质量显著提高,优良率为89.5%（34/38）。术后出现一过性神经根损伤1例,伤口脂肪液化1例,肺部感染2例,内固定钉棒松动1例,交界性后凸1例,无其他严重并发症发生。结论后路有限减压、固定融合手术是治疗成人退变性脊柱侧凸的有效手段,可获得良好的中期临床疗效。Objective To investigate mid-term efficacy of selective posterior decompression,pedicle screw fixation and fusion in the treatment of adult degenerative scoliosis（ADS）. Methods From August 2006 to August 2012,38 patients with ADS were analyzed retrospectively. There were 8 males and 30 females with a mean age of 63.4 years（ranged 52- 78）. Roentgenograph,CT and MRI examination were performed pre-operatively for all the patients. Preoperative Cobb＇s angle,lumbar lordotic angle（LLA）,the distance between C7 plumb line and upper edge of S1 vertebral body（sagittal vertical axis,SVA） and the distance between C7 plumb line and center sacral vertical line（CSVL） were 23.5°±8.5°,21.4°±10.8°,（6.9±5.5）cm and（7.2±5.6）cm,respectively. Selective posterior decompression,pedicle screw fixation and fusion were carried out for all the patients. The visual analogue scale（VAS） and quality of life SF-36 questionnaire scores were used to evaluate the therapeutic effect. Results All patients were operated successfully. The mean follow-up period was 4.2 years（ranged 2.5- 4.8 years）,and no patient was lost to follow-up. Compared with the pre-operation,low back pain and leg pain VAS scores,Cobb＇s angle,LLA,SVA,and CSVL were significantly improved at 3 months post-operation and final follow-up,and the differences were statistically significant（P〈0.05）. According to SF-36 score,therapeutic effect was excellent in 22 cases,good in 12,fair in 2,poor in 2. Health status and quality of life were significantly improved in 34 patients,and the effectiveness rate was 89.5%（34/38）. Postoperative transient nerve root injury occurred in 1 case,wound fat liquefaction in 1,pulmonary infection in 2 cases,internal fixation loosening in 1and junctional kyphosis in 1 during the follow-up. No other severe complications happened. Conclusion The selective posterior decompression,pedicle screw fixation and fusion is effective in the treatment of ADS,can achieve good mid-term clinical efficacy and improve t

关 键 词：腰椎 脊柱侧凸 椎间盘退行性变 减压术 外科 脊柱融合术 

分 类 号：R682.3[医药卫生—骨科学]