退变性腰椎侧凸的临床特点及外科治疗

Clinical characteristics and surgical treatment of the lumbar degenerative scoliosis

目的分析退变性腰椎侧凸的临床特点和外科治疗方法。方法2001年6月至2006年2月手术治疗退变性腰椎侧凸患者112例，均排除先天异常、结核、肿瘤、外伤。男47例，女65例；年龄43～67岁，平均54．7岁；病史6个月～15年，平均3．4年。单纯腰背痛10例，单纯神经根痛21例，腰腿痛76例，合并马尾神经症状者3例，有不同程度的间歇性跛行症状者74例，其中单纯问歇性跛行5例。87例患者腰椎右侧凸，25例左侧凸。术前常规行2～6个月的保守治疗。根据术前患者临床症状和影像学检查结果采用不同的手术治疗方法，包括单纯开窗神经根减压术、多节段开窗或碟形减压术、椎板切除减压植骨融合内固定术等。回顾性分析退变性腰椎侧凸患者的l临床特点、影像学特征、神经根受压特点以及手术治疗的方法和效果。结果78％的患者右侧凸，22％的患者左侧凸，L3和L4神经根多在凹侧受压，而L5和S1神经根则多在凸侧受压。随访时间10个月～5-3年，平均3．1年。疗效评定采用北美脊柱外科学会推荐的Oswestry功能障碍指数（Oswestry disability index，ODI）。手术治疗效果优73例（65％）、良21例（19％），可15例（14％），差3例（3％）。术前腰椎侧凸Cobb角15°-46°，术后Cobb角平均矫正12°。术后随访10个月～5-3年（平均3．1年），骨性融合率分别为1年98％、3年95％和5年95％。结论退变性腰椎侧凸多同时合并其他腰椎退变性疾病，手术治疗的主要目的是解除硬膜囊及神经根压迫、稳定脊柱，矫形次之，后路椎弓根固定减压植骨融合术是有效的治疗方法。

To analyze the Clinical characteristics and surgical treatment of the lumbar degenerative scoliosis（LDS）. Methods 112 patients without congenital, tuberculosis, tumor and trauma disease suffered with LDS were surgically treated from June 2001 to February 2006 in our hospital. There were 47 males, 65 females, with the mean age of 54.7 years （ranged from 43 to 67 years）. The disease history were 6 months to 15 years, with the mean 3.4 years, and only low back pain in l0 patients, only nerve root root pain in 21 patients, low back and leg pain in 76 patients, associated with cauda equina syndrome in 3 cases, with intermittent claudication in 74 cases. 87 patients suffered fight scoliosis and 25 did left. All patients underwent conservative therapy for 2 to 6 months before surgery. Surgical methods depended on the imaging features. The clinical characteristic, imaging feature, presentation of nerve root compression and outcome of surgical treatment of all patients were retrospectively analyzed. Results 78% of the LDS was at the right side and 22% at the left side. L3 and L4 nerve roots were often compressed at the concave side but L5 and Si at the convex. The outcome of surgical treatment showed excellent in 73 cases （65%）, good in 21 cases （19%）, fair in 15cases （14%）and poor in 3 cases （3%）. The eobb＇s angle ranged from 15° to 46° and was corrected averagely 12 degrees after surgery. After mean follow-up of 3.1 years, the solid arthrodsis rate was 98% after 1 year and 95% after 5 years. Conclusion The LDS is often associated with other lumbar degenerative diseases. The main purpose of surgical treatment is decompression of the dura sac and nerve roots and stabilization of the lumbar spine. Correction should be applied cautiously. Decompression and fusion posterior with pedical screws is an effective treatment.