选择性椎管减压加长节段内固定术治疗退行性脊柱侧凸

Selective decompressive laminectomy and long segment internal fusion for degenerative scoliosis

目的 观察选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗超过3个节段的退行性脊柱侧凸的疗效.方法 2003年1月至2009年7月,对52例超过3个节段的退行性脊柱侧凸患者采用后路选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗,对其临床效果进行追踪随访.结果 所有患者均获得随访,随访时间12～60个月.腰腿痛缓解情况按Oswestry评分进行评估,术后1周、3个月、12个月Oswestry评分分别为（25.91±9.05）、（26.75±8.37）、（26.90±8.45）分,与术前的（46.35±8.12）分比较差异均有统计学意义（P＜0.05）;冠状位Cobb角由术前的15.23°±3.35°矫正到术后1周的10.02°±3.26°,差异有统计学意义（P＜0.05）.所有患者术后3、6、12个月X线复查均未出现内植物松动、断裂等情况,术后18～24个月椎间及椎板植骨均达到骨性融合.结论 选择性椎管减压、椎间植骨融合加侧凸长节段椎弓根螺钉内固定术治疗退行性脊柱侧凸可取得良好的手术效果.

Objective To observe the operative effect of selective decompressive laminectomy and long segment pedical screw internal fixation for degenerative scohosis beyond 3 segments. Methods During January 2003 to July 2009, 52 cases with degenerative scoliosis beyond 3 segments were treated by posterior selective decompressive laminectomy, intervertebral implanted bone fusion and long segment pedical screw internal fixation, vetebral plate fusion seperately, and all the cases were followed up. Results All the patients were followed up for 12-60 months after operation. The status of back leg pain relief were evaluated through Oswestry score system. The Oswestry score of 1 week,3 months and 12 months after operation were （25.91 ± 9.05）, （26.75 ± 8.37）, （26.90 ± 8.45） scores respectively and there was statistical significance compared to the preoperative [（46.35± 8.12） scorns] （P 〈0.05）. The average coronal Cobb angle was corrected from 15.23°± 3.35° to 10.02°± 3.26° 1 week after operation （P 〈 0.05）. All the internal implant didn＇t appear loosing or fracture confirmed by X-ray at 3,6,12 months after operation. The intervertebral implanted bone fusion and vetebral plate fusion all got well in 18-24 months after operation. Conclusion Selective decompressive laminectomy and long segment pedical screw internal fixation for the degenerative scoliosis can get better operative effect.