腰椎后路椎间融合(PLIF)固定矫形治疗症状性退变性腰椎侧凸

Posterior lumbar interbody fusion for patients with symptomatic degenerative lumbar scoliosis

目的总结腰椎后路减压、椎间植骨融合(PLIF)手术治疗退变性腰椎侧凸的疗效及安全性。方法通过总结我科近五年治疗31例退变性脊柱侧凸患者,年龄56～77岁,平均63.7岁,其中男性14例,女性17例,随访12～24个月,平均15个月。术前评估包括详细体格检查,腰、腿痛VAS评分,ODI评分;影像学检查包括站立位腰椎正侧位片、腰椎MRI;所有患者均行腰椎后路减压,退变间隙椎间撑开、植骨、椎弓根螺钉内固定术,术后1、3、6、12个月随访,复查VAS、ODI及X线平片。结果术前腰、腿部VAS评分分别为6.5分和4.7分;ODI术前评分为57.7%;术前腰椎侧凸Cobb角平均为22.8°,腰椎生理前凸角为20.7°。末次随访腰、腿部VAS评分为3.3分和2.4分;ODI评分为30.3%;腰椎侧凸Cobb角平均为9.8°,腰椎生理前凸角为32.1°;以上差异均有统计学意义。未发生椎弓根螺钉断裂及松动,有7例相邻上位间隙进一步发生退变,但患者功能提高,未再手术;无神经瘫痪、深部感染及死亡等严重并发症。结论腰椎退变性侧凸经腰椎后路减压椎间融合矫形椎弓根螺钉内固定既可以矫正不对称性退变,又可以去除疼痛源,恢复腰椎生理前凸,具有手术相对安全、椎弓根螺钉固定牢固等优点,是提高患者功能的有效治疗方法。

Objective To investigate the efficacy and safety of posterior lumbar interbody fusion（PLIF） for patients with adult degenerative lumbar scoliosis.Methods From June 2006 to June 2009,31 patients with degenerative lumbar scoliosis were treated with instrumented PLIF.Mean age of the 17 females and 14 males was 63.7 years（range,56 to 77 years）.Clinical（VAS and ODI） and radiographic（Cobb angle and lumbar lordosis angle） outcomes were retrospectively reviewed for each case at a median follow-up 15 months（range,12 to 24 months）.Results At most recent follow-up,the average lumbar VAS score was significantly lower than the pre-operative score（3.3 vs 6.5;P0.001）,either was the lower extremity（2.4 vs 4.7 P0.001）.The average ODI score was significantly lower than the pre-operative score（30.3% vs.57.7%;P0.001）.The average lumbar scoliosis angles were significantly less than preoperative angles（9.8 vs.22.8 degrees;P0.001）,resulting in a reduction in mean scoliosis angles of 57%.The average angles of lumbar lordosis were significantly higher than preoperative angles（32.1 vs.20.7 degrees;P=0.001）,an increase in mean lumbar lordosis angles of 35.5%.No perioperative deaths or major medical complications occurred.Conclusion PLIF after laminectomy in patients with degenerative lumbar scoliosis can restore disc height,lumbar lordosis,removal discogenic pain tissue.The results demonstrate it is an effective and safe procedure.