老年退变性腰椎侧凸合并腰椎管狭窄的手术疗效

Surgical treatment of degenerative lumbar scoliosis accompanying spinal stenosis in elderly patients

目的探讨手术治疗老年退变性腰椎侧凸合并腰椎管狭窄的临床疗效。方法回顾性分析本院从2004年1月至2008年1月收治的退变性腰椎侧凸合并腰椎管狭窄患者37例,包括男性15例,女性22例,年龄(57.6±5.8)岁,比较患者手术前后及末次随访时的Cobb角、ODI功能评分。结果本组病例都获得了临床随访,随访(18.5±5.5)个月,患者术后临床症状明显改善,自诉生活质量明显提高;术前ODI功能评分(59.6±12.5)分,术后(34.6±8.6)分,差异有统计学意义(P<0.05),末次随访时评分(36.3±6.8)分,与术前比较差异有统计学意义(P<0.05);Cobb角由术前(25.3±5.7)°矫正至术后(11.4±6.3)°,改善率平均为84.5%;骨融合率达到100%,无椎间融合器移位、椎间隙塌陷、断钉断棒等发生。结论后路减压结合椎弓根螺钉固定融合矫形术是治疗退变性腰椎侧凸合并腰椎管狭窄的有效方法之一。

Objective To study the clinical outcome of degenerative lumbar scoliosis accompanying spinal stenosis in elderly patients.Methods Thirty-seven patients（15 males and 22 females aged 57.6±5.8 years） with degenerative lumbar scoliosis,admitted to our hospital from January 2004 to January 2008,were retrospectively analyzed.Their Cobb angle and Oswestry disability index（ODI）were compared before and after operation and at the last follow-up time.Results All the patient included in this study were followed-up for 18.5±5.5 months.Their clinical symptoms and life quality were significantly improved after operation.The ODI was significantly higher before operation than after operation and at the last follow-up time（59.6±12.5 vs 34.6±8.6 and 36.3±6.8,P〈0.05）.The Cobb angle was significantly larger before operation than after operation（25.3±5.7 vs 11.4±6.3,P〈0.05） with a correction rate of 84.5% and a bone fusion rate of 100%.No relevant complication such as vertebra fusion shift,intervertebral space collapse,and screw breakage occurred.Conclusion Combined posterior decompression and vertebral arch pedicle screw fixation fusion is one of the effective procedures for degenerative lumbar scoliosis accompanying spinal stenosis in elderly patients.