成人退变性腰椎侧凸个体化治疗方案的选择

Selective Individualization Treatment for Adult Degeneration Lumbar Scoliosis

目的：评价个体化治疗方案对成人腰椎退变性侧凸（adultdegenerationlumbarscoliosis，ADLS）的临床疗效。方法：2007年7月至2011年7月，对46例ADLS患者根据其临床症状、腰椎畸形的程度及特点采取不同的手术方法进行治疗。记录并比较患者术前、术后3个月及末次随访时Oswestry功能评分、侧凸角及腰椎前凸角。结果：46例均获得随访，时间10～36个月。Oswestry功能评分术前（39．89±10．76°）分，术后3个月为（14．45±8．45）分，末次随访（18．45±7．56）分；侧凸Cobb角术前为22．08°±6．43°，术后3个月13．34°±4．47°，末次随访时14．33°±2．56°；腰椎前凸角术前15．45°±10．56°，术后3个月25．34°4．57°末次随访时为24．78°±9．70°各观察项目统计数据术后3个月及末次随访与术前比较，差异均有统计学意义（P〈0．05）。结论：成人腰椎退变性侧凸的治疗主要以缓解症状为目的，根据不同的临床症状和影像学表现制定个体化治疗方案能够取得满意的临床疗效。

Objective： To investigate the clinical outcomes of selective individualization treatment for a dult degeneration lumbar scoliosis. Methods：From July 2007 to July 2011,46 cases with adult degeneration lumbar scoliosis were received different surgery methods according to their clinical symptoms and the degree of spinal deformity. Oswestry score was observed in all patients; scoliosis Cobb angle and lumbar lordosis angle were observed in surgery. All data were recorded before operation, 3 months after operation and final followup. Results： The average followup period was 10-36 months. Preoperation Oswestry score was 39.89 ± 10.76,3 months after operation, it was 14.45± 8.45 ,final followup was 18.45 ±7.56. Preoperation scoliosis Cobb an gle was 22.08 ± 6.43 , 3 month after operation, it was 13.34 °± 4.47 °, final followup was 14.33 °± 2.56°. Preoperation lumbar lordosis angle was 15.45° ±10.56°, 3 months after operation, it was 25.34° ±4.57°, fi nal followup was 24.78°± 9.70°. There were significant differences between preoperation and 3 months postop eration, preoperation and final followup data （ P 〈 0.05 ）. Conclusions ： The treatment for aduh degenerative scoliosis should be focused on clinical presentations. Selective surgical treatment according to clinical and radio logical characteristics can achieve satisfactory clinical outcomes.