后路椎管间接减压矫形融合术治疗退变性成人特发性脊柱侧凸患者的临床研究

Clinical result of indirect decompression surgery for degenerative adult idiopathic scoliosis

[目的]探讨椎管间接减压术治疗退变性成人特发性脊柱侧凸的可行性及有效性。[方法]从2004年6月～2008年12月连续收治因退变因素导致下肢神经根症状的成人特发性脊柱侧凸患者27人,对患者采用后路椎管间接减压矫形融合术治疗。详细记录其术前术后及随访时的各项临床资料及影像学资料,分析手术的临床疗效。[结果]术后随访平均30.8个月(24～78个月),无明显不良反应发生。所有患者神经根症状均得到明显改善,统计学结果表明术后及末次随访时的冠状面Cobb角、侧滑距离、胸段后凸角、胸腰段后凸角、腰段前凸角、VAS和ODI评分均较术前有明显改善。[结论]采用经后路椎管间接减压矫形融合手术治疗伴有下肢神经根症状且合并椎体侧方滑移和(或)椎间孔狭窄的成人特发性脊柱侧凸患者可取得良好疗效。但需严格掌握手术适应证。

[ Objective ] To explore the feasibility and effectiveness of indirect decompression surgery for degenerative adult idiopathic scoliosis. [ Methods ] Twenty - seven degenerative adult idiopathic scoliosis patients were recruited from June 2004 to December 2008. All patients underwent posterior pedicle screw fixation and posterior bone grafting without laminectomy or foraminotomy. We recorded the details of the therapy, made the follow - up each year, then evaluated clinical result. [ Results ] Twenty - seven patients were followed for the average of 30. 8 months. No serious complication were observed. At the postopera- tive and final follow - up, the Cobb angle, lateral olisthesis, thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, VAS and ODI scores, were remarkly better than preoperative. [ Conclusion] The indirect deompression surgery can be effective in degenerative adult idiopathic scoliosis patients. The clinical result of this surgery is satisfying on the promise of strict operation indication and contraindication.