经后路手术治疗腰椎管狭窄症伴退行性腰椎侧凸的临床疗效观察  

Observation of clinical effect of posterior surgical treatment for spinal stenosis with lumbar degenerative de novo scoliosis

作　　者：韩伟峰[1] 刘宝戈[1] HAN Weifeng LIU Baoge.(Department of Orthopedics, Beifing Tiantan Hospi- tal,Affiliated to Capital Medical University, Beijing 100050, China)

机构地区：[1]首都医科大学附属北京天坛医院骨科,100050

出　　处：《临床外科杂志》2017年第2期141-144,共4页Journal of Clinical Surgery

摘　　要：目的观察椎管狭窄症合并退行性腰椎侧凸的手术疗效,探讨手术方式及固定节段的选择。方法椎管狭窄症合并退行性腰椎侧凸症患者27例。采用后路有限减压、固定、融合手术进行治疗并随访。术后及末次随访时测量Cobb角、腰椎前凸角、C7铅垂线(C7PL)与S1椎体后上缘距离(SVA),C7PL与骶骨中线距离(CVA),并与术前进行比较,术后采用JOA评分评估临床疗效,运用SF-36调查问卷对患者治疗前和末次随访时生活质量变化情况进行评价。结果所有患者获得随访,平均20个月。患者术前、术后及末次随访时的Cobb角分别为(22.1±10.5)、(10.2±7.3)°和(10.4±4.8)°,腰椎前凸角分别为(21.2±10.3)°、(25.7±12.2)°和(25.3±12.3)°,SVA分别为(7.5±6.1)cm、(0.6±3.1)cm和(0.5±2.4)cm,CVA分别为(6.9±5.3)cm、(2.8±1.3)cm和(2.9±1.2)cm,与术前比较差异有统计学意义(P<0.05),且术后矫正效果持续性良好,术后与末次随访结果比较,差异无统计学意义(P>0.05)。JOA评分:术前、术后及末次随访时分别为(10.8±1.4)分、(21.3±2.4)分和(23.5±2.3)分;SF-36调查问卷表中的8个维度分值与术前比较,明显改善(P<0.05)。结论根据患者症状、体征及影像学资料制定个体化手术方案,进行选择性减压、融合及固定可以取得满意的临床疗效。Objective To investigate clinical effect of surgical treatment for spinal stenosis with lumbar degenerative de novo scoliosis with spinal stenosis. To discuss selection of operation methods and ranges of fusion. Methods 27 patients of degenerative scoliosis with spinal stenosis were treated by oper- ation. We performed posterior decompression on the segments and selected fusion, then performed correc- tion deformity. Measured Cobb ＂s angle, lumbar lordosis angle, the distance between C7 plumb line （C7PL）, upper edge of S1 vertebral body（SVA）, and the distance between C7PL and center sacral verti- cal line（CVA） after operation and final follow up were compared with preoperative data. JOA score system were used to evaluate clinical effects. The SF-36 questionary was used to evaluate the patients＇life quality before and after operation as well. Results All patients were followed up with an average of 20 months. Preoperative,postoperative and final follow up, Cobb＇s angle was （ 22.1±10.5 ）°, （ 10.2 ±7.3 ）° and （ 10.4± 4.8 ） °, respectively; lumbar lordosis angle was （ 21.2 ± 10.3 ）°, （ 25.7 ± 12.2） ° and （ 25.3 ± 12.3）°, respectively; SVA was （ 7.5 ± 6. 1 ） cm, （0. 6± 3.1 ） cm and （ 0. 5 ± 2.4 ） cm, respectively; CVA was （6.9 ± 5.3 ） cm, （2.8 ± 1.3 ） cm and （2.9± 1.2 ） cm, respectively. There was significant difference in data before and after operation（P 〉 0.05）. JOA score was 10.8 ± 1.4,21.3 ± 2.4 and 23.5±2.3, re- spectively; All domains of SF-36 score were significantly improved postoperatively （ P 〈 0.05 ）. Conclu- sion For surgical treatment with limited decompression, pedicle screw fixation and fusion will be effective methods for degenerative scoliosis with spinal stenosis,individualized surgery design should be made ac- cording to clinical symptoms, signs and imaging features.

关 键 词：退变性腰椎侧凸 腰椎管狭窄 减压 融合 

分 类 号：R687.3[医药卫生—骨科学]