Lenke-Silva分型在退变性脊柱侧弯治疗的临床应用及疗效分析  

Clinical Outcome and Analysis of Lenke-Silva Classification for the Treatment of Degenerative Lumbar Scoliosis

作　　者：刘晓印 张建群[1] 马荣[1] 陈振[1] 梁思敏[1] 丁惠强[1] 吴鹏[1] 马宗军[1] 丁小力[1] 戈朝晖[1] LIU Xiaoyin;ZHANG Jianqun;MA Rong;CHEN Zhen;LIANG Simin;DING Huiqiang;WU Peng;MA Zongjun;DING Xiaoli;GE Zhaohui(Department of Orthopedics,the General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院骨科

出　　处：《宁夏医科大学学报》2019年第7期671-677,共7页Journal of Ningxia Medical University

基　　金：国家自然科学基金（81460335)

摘　　要：目的分析并评估Lenke-Silva分型在国人退变性脊柱侧弯(DS)临床应用中的价值与临床意义。方法回顾性分析2011年3月至2018年6月在我院接受手术治疗的DS患者58例。全部病例参照Lenke-Silva分型标准分级指导治疗:1级行单纯减压(7例);2级行后路减压并短节段融合固定(14例);3级行短节段固定并侧弯矫形(12例);4级行矫形恢复腰椎前凸(10例);5级行长节段融合固定至胸椎(9例);6级均行截骨矫形(6例)。对比患者手术前后矢状面平衡(SVA)、冠状面平衡(C7PL-CSVL)、腰椎Cobb角、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、PI与LL匹配度(PI-LL)测量结果。比较患者手术前后Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(VAS)和脊柱侧弯协会22项问卷表(SRS-22)评分。结果所有患者均获得随访,随访时间11个月~4年,平均15.3个月,所有患者术后6个月及末次随访VAS、ODI均小于术前,SRS-22评分均较术前升高(P<0.05);影像学评估:1~2级患者术后6个月、末次随访Cobb角、LL、PT、PI-LL与术前比较差异均无统计学意义(P均>0.05);3~6级患者术后6个月、末次随访Cobb角、PT、PI-LL均小于术前,LL大于术前(P均<0.05)。结论依据Lenke-Silva分型为指导制定手术方案的所有病例均取得了满意的临床疗效,该分型对于国人DS患者临床应用可行,对临床诊疗具有一定指导意义。Objective To evaluate the clinical application and it’s significance of Lenke-Silva classification in the treatment of degenerative lumbar scoliosis.Methods Fifty-eight patients who underwent spinal surgery in our hospital from March 2011 to June 2018 were included in this retrospective study.According to the Lenke-Silva classification,Grade one:decompression alone(n=7);Grade two:decompression with short segment fusion fixation(n=14);Grade three:the correction of scoliosis curvature and short segment fusion fixation(n=12);Grade four:recorrection and restoration of the lumbar lordosis(n=10);Grade five:extending the fusion and instrumentation into the thoracic region(n=9);Grade six:osteotomy(n=6).The sagittal vertical axis(SVA),the distance from C7 plumb line to central sacral vertical line distance(C7PL-CSVL),lumbar Cobb angle,lumbar lordosis(LL),pelvic tilt(PT),pelvic incidence(PI),the matched degree between pelvic incidence and lumbar lordosis(PI-LL)were compared before and after operation.The score result of visual analogue scale(VAS),Oswestry score(ODI),scoliosis research society-22(SRS-22)before and after operation were compared.Results All patients were followed up for 11 months to 4 years,with an average of 15.3 months.VAS and ODI were less than preoperative,SRS-22 were higher than preoperative in all patients at 6 months and the last follow-up(P<0.05).Imaging evaluation:Cobb angle,LL,PT,PI-LL of patients with grade 1-2 had no statistical difference compared with preoperative 6 months and last follow-up.The Cobb angle,PT and PI-LL of patients with Grade 3-6 were less than those before operation at 6 months after operation and the last follow-up(P<0.05),while LL was larger than that before operation(P<0.05).Conclusion According to Lenke-Silva classification,satisfactory clinical results have been achieved in all cases of surgical planning.This classification is feasible for Chinese patients with DS,and has significance for clinical diagnosis and treatment.

关 键 词：退变性脊柱侧弯 Lenke-Silva分型 临床疗效 

分 类 号：R681.5[医药卫生—骨科学]