短节段固定融合术治疗退变性腰椎侧凸合并腰椎管狭窄疗效观察  

Clinical effect analysis of short-segment fixation and fusion for degenerative lumbar scoliosis combined with lumbar stenosis

作　　者：王磊[1] 李天旺[1] 刘建强[2] 刘晓宗[3] 王照国 田艳[1] 张永兴[1] 王伟[1] 

机构地区：[1]解放军第252医院脊柱外科,河北保定071000 [2]保定市骨科医院骨科,河北保定071000 [3]保定市第一中心医院烧伤整形科,河北保定071000 [4]保定市阜平县医院骨科,河北保定073200

出　　处：《临床骨科杂志》2016年第3期294-297,共4页Journal of Clinical Orthopaedics

摘　　要：目的：探讨短节段固定融合术治疗退变性腰椎侧凸（ DLS）合并腰椎管狭窄的手术策略、影像学及临床疗效。方法选择性减压、短节段固定融合术治疗68例DLS合并腰椎管狭窄患者，比较患者术前及末次随访时的Cobb角、腰椎前凸角、冠状面躯干偏移及矢状面躯干偏移。以Oswestry 功能障碍指数（ ODI）评估患者功能改善情况。结果患者均获得随访，时间36～60个月。 Cobb角术前12°～28°（15.9°±4.6°），末次随访3.6°～9.8°（5.2°±3.1°）；腰椎前凸角术前1.2°～3.3°（1.9°±2.9°），末次随访－28.1°～4.6°（－23.6°±3.7°）；冠状面躯干偏移术前8.2～13.7（10.8±5.2）mm，末次随访2.8～5.6（4.3±1.8）mm；矢状面躯干偏移术前10.2～15.6（12.6±3.7）mm，末次随访3.1～6（4.6±2.2）mm；ODI评分术前25.2～29.8（27.6±2.1）分，末次随访2.1～4.2（3.6±1.3）分。以上各项指标末次随访与术前比较差异均有统计学意义（P＜0.05）。术后早期并发症发生率为7.3％。末次随访时未发现钉棒松动或断裂等情况。结论对于冠状面Cobb角＜30°且躯干失平衡较小的DLS合并腰椎管狭窄患者，行选择性减压、短节段固定融合可获得良好的中期临床疗效。Objective To investigate the surgical strategies and clinical results of short-segment fixation and fusion for degenerative lumbar scoliosis （ DLS） combined with lumbar stenosis .Methods Sixty-eight cases of DLS with lumbar spinal canal stenosis underwent selective decompression and short segmental fixation and interbody fusion .The Cobb angle, lumbar lordosis, coronal plane trunk shift , and sagittal plane trunk shift in the preoperative and final follow-up were measured .Function were assessed by Oswestry disability index （ ODI） .Results All the patients were followed up for 36-60 months.The Cobb angle was 12°-28°（15.9°±4.6°） preoperatively and was 3.6°-9.8°（5.2°± 3.1°）at final follow-up;lumbar lordosis was 1.2°-3.3°（1.9°±2.9°） preoperatively and was -28.1°-4.6° （-23.6°±3.7°） postoperatively;coronal plane trunk shift was 8.2-13.7 （10.8 ±5.2 ） mm preoperatively and was 2.8-5.6（4.3 ±1.8）mm at final follow-up;sagittal plane trunk shift was 10.2-15.6（12.6 ±3.7）mm preoper-atively and was 3.1-6（4.6 ±2.2）mm at final follow-up;the ODI was 25.2-29.8（27.6 ±2.1）points preoperative-ly and was 2.1-4.2（3.6 ±1.3）points at final follow-up.There were statistically significant differences in the above indexes between the final follow-up and the preoperative comparison （ P〈0.05 ） .The early complication incidence rate was 7.3%.At the final follow-up, there was no instrument-related failure.Conclusions The selective decom-pression and short-segment fixation and fusion is an safe and effective technique for DLS combined with spinal stenosis patients with small Cobb angle （〈30°） and minor spinal imbalance .

关 键 词：退变性脊柱侧凸 短节段 腰椎管狭窄 腰椎融合术 

分 类 号：R681.57[医药卫生—骨科学] R687.3[医药卫生—外科学]