退行性腰椎侧凸合并椎管狭窄症的手术治疗

Surgical treatment of degenerative lumbar scoliosis with spinal stenosis

目的:探讨后路有限减压、固定、融合手术治疗退行性腰椎侧凸合并椎管狭窄症的疗效。方法:2002年6月至2009年1月,收治退行性腰椎侧凸合并椎管狭窄症患者26例,男6例,女20例;年龄51～72岁,平均61.3岁;合并椎管狭窄症病程11个月～6年,平均36个月。所有患者术前均行X线、CT及MRI检查,6例患者行脊髓造影检查,术前Cobb角为(22.0±10.1)°,腰椎前凸角为(21.6±10.2)°,C7铅垂线(C7PL)与S1椎体后上缘距离(SVA)为(7.6±6.4)cm,C7PL与骶正中线距离(CSVL)为(6.8±5.6)cm。采用后路有限减压、固定、融合手术进行治疗,术后进行随访。术后及末次随访时测量Cobb角、腰椎前凸角、SVA、CSVL并与术前进行比较;采用腰痛JOA评分系统进行疗效评估。结果:手术时间110～185min,平均140min;出血量480～850ml,平均620ml。所有患者获得随访,时间1.3～5年,平均2.5年。患者术后及末次随访时的Cobb角分别为(10.5±8.2)°、(8.8±5.2)°,腰椎前凸角分别为(25.4±14.2)°、(31.6±13.2)°,SVA分别为(0.6±3.3)cm、(-1.2±2.5)cm,CSVL分别为(2.8±1.3)cm、(1.6±1.2)cm,较术前均有明显改善。JOA评分:术前(11.0±1.7)分,术后即刻(22.4±2.4)分,末次随访时(24.0±2.1)分,结果:优13例,良8例,可3例,差2例。术后1例患者发生矫正丢失,无椎间隙塌陷、神经损伤、钉棒断裂等并发症。结论:后路有限减压、固定、融合手术是治疗退行性腰椎侧凸合并椎管狭窄症的有效手段。

Objective： To investigate the clinical effects of limited decomression, fixation, and fusion in treating degenera- tive scoliosis with spinal stennosis. Methods： From June 2002 to January 2009,26 patients of degenerative scoliosis with spinal stenosis were treated with limited decomression, fixation, and fusion. There were 6 males and 20 females with an average age of 61.3 years （ranged, 51 to 72 years）. Course of disease of spinal stenosis was from 11 months to 6 years with an average of 36 months. X-ray, CT, MRI examination were performed preoperatively for all the cases and myelography was performed for 6 cas- es. Preoperative Cobb＇s angle,focal lordosis angle,the distance between C7 plumb line （CTPL） and upper edge of $1 vertebral body （SVA） ,and the distance between CTPL and center sacral vertical line （CSVL） were （22.0±10.1）, （21.6±10.2）~, （7.6± 6.4） cm, （6.8±5.6） cm respectively. Measured Cobb＇s angle ,focal lordosis angle, SVA, CSVL after operation and final follow- up were compared with preoperative data. JOA score system were used to evaluate clinical effects. Results：The operative time was from 110 to 185 rain with an average of 140 rain;volume of blood loss was from 480 to 850 ml with an average of 620 ml. All the patients were followed up from 1.3 to 5 years with an average of 2.5 years. Postoperative and final follow-up, Cobb＇s an- gle was （10.5±8.2）°, （8.8±5.2）°,respectively;focal lordosis angle was （25.4±14.2）°, （31.6±13.2）°,respectively; SVA was （0.6±3.3） cm, （-1.2±2.5） cm, respectively ; CSVL was （2.8±1.3） cm, （ 1.6± 1.2） cm, respectively. There was significant differ- ence in data before and after operation. Preoperative, instantly postoperative, final fallow-up, JOA score was 11.0＋ 1.7,22.4± 2.4,24.0±2.1, respectively; 13 cases obtained excellent results, 8 good, 3 fair, 2 poor. Loss of correction occurred in one case. No collapse of intervertebral space, nerve injury, breakage of fixation system were found. Conclusion：Surgical treatment with limited decompression, pedicle screw fixation and fusion is effective method for degenerative scoliosis with spinal stenosis,in- dividualized surgery design should be made according to clinical symptoms, signs and imaging features.