退变性腰椎侧凸两种手术方式的疗效观察

The clinical results of 2 surgical methods in the treatment of degenerative lumbar scoliosis

目的探讨退变性腰椎侧凸不同手术治疗方法的适应证选择,观察不同治疗方法的疗效。方法 31例退变性腰椎侧凸患者,男8例,女23例。平均年龄55.3岁(51～76岁),平均病程8.6年(4-17年),腰椎侧弯Cobb's角平均23.5°(15°～44°)。根据患者不同的临床表现,选择两种手术方法 :A组(19例)以广泛腰痛症状为主诉,伴有失平衡状态,行椎弓根螺钉器械长节段固定矫形、椎管多节段开窗减压、横突间植骨融合;B组(12例)以下肢神经压迫症状为主诉,腰痛轻微,平衡良好。行短节段椎弓根螺钉固定(1～2个运动节段)、选择性椎管开窗减压、椎体间或横突间植骨融合。两组均术后1-2周佩带腰背支具活动,支具佩带3-6个月。结果术后平均随访24.7个月(16-67个月),29例(93.5%)疼痛消失或仅感轻微疼痛,两组组内手术前、后VAS评分和Oswesry功能障碍指数(ODI)评分有统计学差异。A、B两组组间比较,在手术时间和手术出血量上有统计学差异,而术后疼痛VAS评分和Oswestry功能障碍指数改善率均无统计学差异。结论退变性腰椎侧凸两种手术方式的疗效均满意。根据退变性腰椎侧凸不同的手术适应证,选择合适的手术方式是提高疗效的关键。

Objective To investigate the indications of different methods in the treatment of degenerative lumbar scoliosis, and to observe the efficacy of different treatment methods. Methods 31 patients with degenerative lumbar scoliosis were selected, among whom there were 8 males and 23 females, with an average age of 55.3 years old （range; 51-76 years）, an average disease course of 8.6 years （range; 4-17 years） and the preoperative mean Cobb＇s angle of 23.5~ （range; 15^-44~）. 2 surgical methods were chosen based on the different clinical manifestations of patients. Group A （n=19）： patients who complained of a wide range of low back pain with loss of balance underwent long- segment pedicle screw fixation, multi-segmental decompression and intertransverse bone graft fusion. Group B （n= 12）： patients who complained of lower extremity nerve compression with minor low back pain and good balance underwent short-segment pedicle screw fixation （1-2 motion segments）, selective spinal canal decompression and interbody or intertransverse bone graft fusion. 1-2 weeks after surgery, patients in both groups could move with back braces, which should be worn for 3-6 months. Results After surgery the patients were followed up for a mean period of 24.7 months （range; 16-67 months）. Pain disappeared or only slight pain occurred in 29 patients （93.5%）. The visual analogue scale （VAS） scores and Oswestry Disability Index （ODI） in the 2 groups before and after the surgery were statistically and significantly different. Statistically significant differences existed in operative time and blood loss between the 2 groups. Postoperatively, the rates of improvement in VAS scores and ODI between the 2 groups were not significantly different. Conclusions The efficiency of the 2 surgical methods in the treatment of degenerative lumbar scoliosis is satisfactory. The key to improve the efficacy is to choose proper surgical methods based on different indications of degenerative lumbar scoliosis.