单纯减压治疗腰椎管狭窄症合并退变性腰椎侧凸

Treament of Spinal Stenosis and Degenerative Lumbar Scoliosis with Decompression Alone

目的探讨单纯减压治疗合并退变性腰椎侧凸的腰椎管狭窄症的临床效果及手术适应证，并观察退变性腰椎侧凸的转归。方法回顾性分析1995年1月至2005年12月间，我院治疗并获得随访的单纯减压手术治疗的腰椎管狭窄症合并退变性腰椎侧凸患者28例，其中男10例，女18例，年龄61～89岁，平均65．1岁。本组患者以间歇性跛行和根性疼痛为主要症状，无冠状位及矢状位的失平衡，前屈后伸动力位片无不稳定的表现，侧凸顶椎Nash—Moe旋转分级小于等于11°，左右侧屈位椎体间侧方滑移小于等于5mm。计算平均手术时间和术中出血量。比较患者手术前后腰痛及腿痛的视觉模拟评分、Oswestry功能障碍指数、腰椎前凸角、侧凸角的变化。结果28例患者平均随访8．3年（5—16年），手术过程顺利，手术时间（95±16）min，平均术中出血量（183±32）mL，1例行自体血回输，无异体血输入病例。脑脊液漏1例，经改变体位及换药局部处理后愈合；1例切口脂肪液化，经换药对症处理后愈合。围手术期无死亡病例，术后症状无加重，神经功能无恶化。术后1年随访及末次随访时腿痛视觉模拟评分、Oswestry功能障碍指数均较手术前明显降低，差异有统计学意义（P〈0．05）；腰痛视觉模拟评分虽较术前有所减小，但差异无统计学意义（P〉0．05）。虽然腰椎前凸角减小，但进展缓慢，与治疗前比较无统计学意义（P〉0．05）。术后腰椎侧凸角虽有所减小，但差异无统计学意义（P〉0．05）。结论单纯减压治疗腰椎管狭窄症合并退变性腰椎侧凸创伤小、并发症少，能够较好解除压迫，缓解神经症状，对腰椎稳定性的影响较小，容易被老年人接受，但应严格掌握手术适应证，并注意责任节段的判断和处理。

Objective To investigate the indications and outcomes of decompression alone for spinal stenosis with degen- erative lumbar scoliosis and observe the change of degenerative scoliosis. Methods From January 1995 to December 2005,28 patients of spinal stenosis and degenerative lumbar scoliosis were treated with posterior decompression alone. These patients had the main symptom of intermittent claudication and radicular pain, no coronal and sagittal imbalance, no unstable perform- ance of scoliosis apical vertebra Nash- Moe rotation grade ≤11° ,vertebral body side slip ≤5 mm in dynamic lateral flexion. The average operative time and blood loss were calculated. The VAS of low back and lower extremity pain, ODI, lumbar lordosis angle and scoliosis Cobb angle were measured and compared in patients before and after treatment. Results Twenty eight ca- ses （mean age 65.1 years old,53 males,74 females） had successful surgery,with mean operative time of（95±16） mins and average blood loss of（ 183±32） mL. The mean follow- up period of 8.3years （5 -16years）. There were one case of autolo- gous blood transfusion without allogenic blood transfusion. There were one cases of cerebrospinal fluid leakage （ healing with changing position and dressing）and one case of wound fat liquefaction （healing with dressing）. There were no perioperative deaths, no postoperative symptoms and neurological deterioration. The leg VAS and ODI were significantly lower than preopera- tive with statistical significant difference （P 〈 0.05 ）. Although low back VAS decreased compared with preoperative, but the difference was not statistically significant（ P 〉 O. 05 ）. Although lordosis angle decreased and scoliosis angle decreased,but the change was slowly and no significant difference （P 〉 0.05）. Conclusion Decompression alone for treatment of lumbar spinal stenosis with degenerative lumbar scoliosis has less trauma, fewer complications, good symptoms alleviation, enough decompres- sion of nerve roots,less destroy of spinal stability. Therefore, it easy to accept for elderly. However, the indications should be controlled strictly and responsible segment should be judged and managed accurately.