长节段固定、局限性减压治疗合并退变性腰椎侧凸的腰椎管狭窄症

Long-segment Fixation and Limited Decompression in the Treatment of Lumbar Canal Stenosis Combined with Degenerative Lumbar Scoliosis

目的评价后路长节段固定、局限性减压治疗合并退变性腰椎侧凸的腰椎管狭窄症的临床疗效。方法 2005年6月至2009年8月收治的合并退变性腰椎侧凸的腰椎管狭窄症患者42例,其中男性13例,女性29例,均采用后路长节段固定、局限性减压手术治疗,分析患者术前、术后JOA评分、Oswestry功能障碍指数、Cobb角的变化,并进行对比。结果腰椎JOA评分由术前(11.5±3.6)分增加到术后(23.4±2.1)分(P<0.01),临床改善率75.3%;术前ODI为(68.2±2.4)%,术后改善至(34.2±1.7)%(P<0.01);冠状位Cobb角术前为(27.6±2.3)°,术后改善至(10.5±1.5)°(P<0.01);矢状位腰椎前凸角术前为(11.8±1.2)°,术后改善至平均(35.3±1.6)°(P<0.01)。患者全部获得随访,随访时间12～56个月,平均38个月,随访期间除1例因感染内固定物取出,其余41例矫正效果无丢失,内固定物无松动、断裂现象,植骨融合良好,无假关节形成。结论对于合并退变性腰椎侧凸的腰椎管狭窄症患者,掌握合适的手术适应证,后路长节段固定、局限性减压及植骨融合是有效的治疗方法。

Objective To evaluate the clinical results of long-segment fixation and limited decompression for lumbar canal stenosis combined with degenerative lumbar scoliosis.Methods From June 2005 to August 2009,42 patients with lumbar canal stenosis combined with degenerative lumbar scoliosis（29 females and 13 males） underwent the operation of long-segment fixation and limited decompression.The JOA scores,Oswestry disability index（ODI）,and Cobb′s angle were recorded and compared before and after the operation.Results The JOA scores increased significantly from（11.5±3.6） before the operation to（23.4±2.1） after the operation（P〈0.01）.The clinical improvement rate is 75.3%.The procedures resulted in significantly lowered ODI from（68.2±2.4）%before the operation to（34.2±1.7）%after the operation（P〈0.01）.A significant improvement of the coronal Cobb′s angle was achieved after the operation from（27.6±2.3）° to（10.5±1.5）°（P〈0.01）,and the lordosis angle was improved from（11.8±1.2）° to（35.3±1.6）° after the operation（P〈0.01）.All the patients were followed up for 12 to 56 months（mean 38 months）.No loss of correction angle,no implant loosening,displacement or fragmentation or pseudarthrosis was found at the final follow-up,except one case′s implants remove because of infection.Conclusion Posterior longsegment fixation,limited decompression and instrumented fusion has good therapeutic effect in treatment of lumbar canal stenosis combined with degenerative lumbar scoliosis.