后路椎弓根螺钉置入修复退行性腰椎侧凸性椎管狭窄:矫正率及Cobb角恢复状态

Posterior pedicle screw system in repair of degenerative lumbar scoliosis with stenosis: correction rate and Cobb angle recovery

背景:腰椎退变导致腰椎侧凸性椎管狭窄患者单纯椎管减压难以获得长期疗效,因为单纯减压被视为一种医源性的腰椎失稳,从而加重腰椎畸形,选用腰椎后路椎弓根螺钉固定,结合减压植骨融合治疗此类患者取得了良好的疗效。目的:评价采用后路椎弓根螺钉系统后路减压、内固定、植骨融合治疗退行性腰椎侧凸性椎管狭窄的临床疗效。方法:对2009年2月至2012年11月手术治疗的18例退行性腰椎侧凸性椎管狭窄患者进行回顾性分析,其中男6例,女12例,年龄48-80岁,平均62.2岁,腰椎侧凸Cobb角平均为28.6°,均采用后路减压、固定、植骨融合治疗。结果与结论:18例均得到满意随访,平均随访时间为22个月。所有患者均对治疗效果满意,生活质量提高,植入后平均矫正角度为13.7°(6.0°-28.4°),无内固定失败及感染病例。提示腰椎后路减压、内固定、植骨融合是治疗退行性腰椎侧凸性椎管狭窄的有效方法之一。

BACKGROUND：Simple spinal decompression for lumbar degeneration-induced lumbar scoliosis spinal stenosis is difficult to obtain long-term efficacy. Because simple decompression is considered an iatrogenic lumbar instability, and can aggravate lumbar deformity. Posterior lumbar pedicle screw fixation combined with decompression and fusion obtained good curative effects in patients. 〈br〉 OBJECTIVE：To investigate the clinical efficacy of posterior decompression, internal fixation, and bone graft fusion with posterior pedicle screw system in the treatment of degenerative lumbar scoliosis with stenosis. 〈br〉 METHODA retrospective analysis was performed in 18 patients with degenerative lumbar scoliosis with stenosis who received surgical treatment from February 2009 to November 2012. These patients consisted of 6 males and 12 females, with a mean age of 62.2 years （range, 48-80 years）. They had lumbar scoliosis with a mean Cobb angle of 28.6° and underwent posterior decompression, internal fixation, and bone graft fusion. 〈br〉 RESULTS AND CONCLUSION：Al the 18 patients achieved satisfactory fol ow-up. The mean fol ow-up was 22 months. Al patients were satisfied with treatment outcomes and had improved quality of life. The mean correction angle was 13.7° （range, 6.0°-28.4°） after operation. There was no failure of internal fixation, and no infected cases were found. These data inducated that posterior decompression, internal fixation, and bone graft fusion is one of the effective methods for treating degenerative lumbar scoliosis with stenosis.