退变性腰椎侧凸的手术治疗选择

Selective surgical treatment for degenerative scoliosis

目的评价选择性手术治疗退变性腰椎侧凸的临床疗效。方法手术治疗退变性腰椎侧凸患者42例。记录所有患者术前、术后3个月及末次随访的Oswestry功能评分;记录实施内固定治疗患者术前、术后3个月及末次随访的侧凸Cobb角及腰椎前凸角。结果 42例均获随访,时间8～36个月。Oswestry功能评分:术前为39.25分±10.47分,术后3个月为13.85分±7.73分,末次随访为17.95分±6.18分,术后3个月及末次随访数据与术前比较差异均有统计学意义(P<0.05)。实施内固定治疗患者侧凸Cobb角术前为21.05°±8.51°,术后3个月为12.13°±4.83°,末次随访时为14.03°±5.25°,术后3个月及末次随访与术前比较差异均有统计学意义(P<0.05)。腰椎前凸角:术前为14.40°±14.72°,术后为26.62°±11.48°,末次随访时为24.27°±11.03°,术后3个月及末次随访数据与术前比较差异均有统计学意义(P<0.05)。结论退变性腰椎侧凸的治疗主要以缓解症状为目的 ,依据不同的临床及影像学表现制定个体化治定方案能够取得满意的临床疗效。症状消退的同时有助于畸形的改善,可不必过分追求侧凸角度的纠正。

Objective To investigate clinical outcomes of selective surgical treatment for degenerative scoliosis.Methods 42 cases with degenerative scoliosis were undergone surgery.Oswestry score was observed in all patients;scoliosis Cobb angle and lumbar lordosis angle was observed in internal fixation patients.All data was recorded on preoperation,3 months postoperation and last follow-up.Results The average follow-up period was 8～36 months.Preoperation Oswestry score was 39.25±10.47,3 months postoperation was 13.85±7.73,last follow-up was 17.95±6.18.There were significant difference between preoperation and 3 months postoperation,preoperation and last follow-up data(P<0.05).Preoperation scoliosis Cobb angle was 21.05°±8.51°,3 month postoperation was 12.13°±4.83°,last follow-up was 14.03°±5.25°;Preoperation lumbar lordosis angle was 14.40°±14.72°,3 months postoperation was 26.62°±11.48°,last follow-up was 24.27°±11.03°.There were significant difference between preoperation and 3 months postoperation,preoperation and last follow-up data of both scoliosis Cobb angle and lumbar lordosis angle(P<0.05).Conclusions Since improvement of clinical symptoms is helpful in deformity correction;the treatment for degenerative scoliosis should be focused on clinical presentations.Selective surgical treatment according to clinical and radiological characteristics can achieve satisfied clinical outcomes.