后路椎弓根钉系统治疗退变性腰椎侧凸的近期疗效

Short-term therapeutic effect of posterior pedicle screw fixation for treatment of degenerative lumbar scoliosis

目的评价后路椎弓根钉矫形术治疗退变性腰椎侧凸的临床疗效。方法 2006年3月2009年8月收治的退变性腰椎侧凸患者36例,其中男性19例,女性17例;均采用后路减压,椎弓根钉矫形,根据不同患者分别采用椎间植骨融合（15例）或后外侧植骨融合（21例）,分析患者术前、术后JOA评分、Oswestry功能障碍指数（ODI）、Cobb’s角;术后并发症发生情况。结果腰椎JOA评分术后较术前明显增高（P〈0.05）,临床改善率83.3%;术前ODI为（67.1±11.4）%,术后改善至（32.1±10.8）%（P〈0.01）;冠状位Cobb’s角术前平均26.7°,术后改善至平均12.3°（P〈0.01）;矢状位腰椎前凸角术前平均10.7°,术后改善至平均36.6°（P〈0.01）。患者全部获得随访,随访时间平均38个月（1250个月）,随访期间无矫正效果丢失;内固定物无松动、移位、断裂现象,植骨融合良好,无假关节形成。结论后路椎弓根钉矫形、植骨治疗退变性腰椎侧凸畸形可获得良好疗效,充分的术前评估,正确的术式选择是获得良好效果的保证。

Objective To evaluate the short-term outcomes of patients receiving orthopedic surgery with posterior pedicle screw fixation for degenerative lumbar scoliosis. Methods Between March, 2006 and August, 2009, 36 patients with degenerative lumbar scoliosis （19 males and 17 females） underwent procedures of decompression, bone implantation and pedicle screw fixation. Fifteen patients were also treated by PLIF and 21 cases received posterior-lateral fusion. The JOA scores, Oswestry disability index （ODI）, and Cobb angle were recorded before and after the operation, and the surgical complications were also observed. Results The JOA scores increased significantly by 83.3% after the operation （P〈0.05）. The procedures resulted in significantly lowered ODI from （67.1±11.4）% before the operation to （32.1±10.8）% after the operation （P〈0.01）. A significant improvement of the coronal Cobb’s angle was achieved after the operation （26.7° preoperatively vs 12.3° postoperatively, P〈0.01）, and the lordosis angle was improved from 10.7° to 36.6° after the operation （P〈0.01）. All the patients were followed up for 12 to 50 months （mean 38 months）, and no implant loosening, displacement or fragmentation, or pseudarthrosis was found at the final follow-up. Conclusion Posterior pedicle screw fixation shows good short-term therapeutic effect in treatment of degenerative lumbar scoliosis. Individualized surgical plans and adequate preoperative evaluation are keys to successful operations