退变性腰椎侧凸的认知及矫形融合固定治疗  

Cognition of degenerative lumbar scoliosis and its orthopedic fusion and fixation

作　　者：张科峰[1] 刘阳 张存鑫 吕超亮[1] Zhang Kefeng;Liu Yang;Zhang Cunxin;Lü Chaoliang(Department of Spine Surgery,Jining No. 1 People’sHospital,Jining 272111,Shandong Province,China;Department of Joint Surgery,Zhucheng People’s Hospital,Zhucheng 262200,Shandong Province,China)

机构地区：[1]济宁市第一人民医院脊柱外科,山东省济宁市272111 [2]诸城市人民医院关节外科,山东省诸城市262200

出　　处：《中国组织工程研究》2019年第32期5227-5232,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:退变性腰椎侧凸是引起下腰背痛及下肢根性症状和间歇性跛行的常见原因之一,是近年来脊柱退行性疾病中的研究热点。目的:主要对近几年国内外关于退变性腰椎侧凸的认知及治疗方法进行综述,旨在为退变性腰椎侧凸的治疗方案提供参考。方法:以"退变性腰椎侧凸,椎间融合,内固定治疗,手术治疗,椎弓根螺钉,degenerative scoliosis,interbody fusion,internal fixation,operative treatment,pediclescrew"为检索词,分别检索1987年12月至2018年12月发表的与退变性腰椎侧凸、腰椎滑脱症、脊柱不稳、脊柱侧凸、脊柱畸形等的相关文章。根据入选标准及排除标准摘选42篇文献进行综述。结果与结论:(1)成人退行性脊柱侧凸手术的主要适应证是椎间孔狭窄引起的腰背痛、下肢放射痛、麻木及跛行;(2)在选择手术方法时,应仔细评估主要症状和潜在的疾病,不仅要减轻症状,而且要尽量减少术后并发症;(3)由于手术后侧凸的进展,单纯减压术通常不能治愈;在Cobb角较小、旋转畸形最小、冠状位和矢状位不平衡较轻的情况下,可采用减压加短节段固定融合术;在较大的Cobb角和冠状矢状不平衡的情况下,可选择减压加长节段矫形融合固定术;(4)任何用于成人退行性脊柱侧凸的手术都有较高的并发症,因此在选择手术方法之前,应该仔细考虑患者手术的风险和获益。BACKGROUND:Degenerative lumbar scoliosis is one of the common causes of lower back pain and intermittent claudication.It is one of the focus research of spinal degenerative diseases in recent years.OBJECTIVE:To review the cognition and treatment methods of degenerative lumbar scoliosis at home and abroad in recent years,and to provide reference for the treatment of degenerative lumbar scoliosis.METHODS:The articles related to the degenerative lumbar scoliosis,spondylolisthesis,spinal instability,scoliosis,and spinal deformity published between December 1987 and December 2018 were retrieved by computer.The keywords were"degenerative scoliosis,interbody fusion,internal fixation,operative treatment,pedicle screw"in Chinese and English,respectively.Totally 42 articles were enrolled based on the inclusion and exclusion criteria.RESULTS AND CONCLUSION:(1)The main indications for adult degenerative scoliosis surgery are low back pain,radiation pain in lower limbs,numbness and claudication caused by intervertebral foramen stenosis.(2)When choosing the surgical methods,the main symptoms and potential diseases should be carefully evaluated.Not only to reduce symptoms,but also to minimize postoperative complications.(3)Due to the progression of postoperative scoliosis,decompression alone is usually not curable.In the case of small Cobb angle,minimal rotational deformity,light coronal and sagittal imbalances,decompression plus segmentary fixation and fusion can be used.In the case of large Cobb angle and coronal sagittal imbalance,decompression and lengthening segmentary orthopaedic fusion fixation may be selected.(4)Any surgery for adult degenerative scoliosis has a higher incidence of complications,so the risks and benefits of surgery should be carefully considered before selecting a surgical approach.

关 键 词：退变性腰椎侧凸 椎间融合 内固定 短节段固定 长节段固定 减压 椎弓根螺钉 

分 类 号：R459.9[医药卫生—治疗学] R682[医药卫生—临床医学]