后路选择性减压融合术治疗老年退变性腰椎侧凸症

Posterior selected decompression and fusion for degenerative lumbar scoliosis in elderly patients

目的评价后路选择性减压融合术治疗65岁以上老年退变性腰椎侧凸症的临床疗效。方法回顾性分析有完整随访资料的57例患者,根据临床表现及影像学资料确定减压节段,对既有不稳或减压所致的失稳节段进行融合,采用JOA评分、ODI量表及改善率行疗效评估。结果术前JOA、ODI评分分别为(14.7±1.8)、(32.5±6.8)分,末次随访时为(25.3±2.4)、(13.3±4.7)分,手术前后比较差异有统计学意义(P<0.05),手术优良率为78.9%,1例发生内固定断裂。结论充分术前准备和评估,选择合理的个体化方案治疗老年退变性腰椎侧凸症可取得满意的疗效。

Objective To evaluate the clinical efficacy of posterior selected decompression and fusion in treatment of degenerative lumbar scoliosis in elderly patients. Methods Clinical data of 57 patients over 65 years undergoing surgical treatment were retrospectively reviewed. Limited decompression was performed on the involved segments determined by clinical manifestations and radiographic documents. Fixation and fusion were selected on spinal instability. Japanese Orthopedic Association （JOA） and Oswestry Disability Index （ODI） score systems were used to evaluate clinical outcomes. Results The JOA and ODI scores were （14.7 ± 1.8）, （32.5 ±6.8） preoperatively, and （25.3 ±2.4）, （13.3 ± 4.7 ） at last follow-up, respectively. The preoperative and postoperative indexes all showed significant differences （ P 〈 0.05 ）. Rate for excellent or good outcome was 78.9%. Failure of instrumentation happened in one case. Conclusion Posterior selected decompression and fusion is an efficient surgical modality for degenerative lumbar scoliosis in elderly patients.