后路减压内固定融合治疗退变性腰椎侧凸

Posterior lumbar interbody fusion in treatment of degenerative lumbar scoliosis

目的探讨后路减压内固定植骨融合治疗退变性腰椎侧凸的临床疗效。方法后路减压内固定植骨融合治疗19例退变性腰椎侧凸患者。手术前后进行JOA、VAS评分评估临床疗效,影像学测量比较手术前后的Cobb角、骨盆倾斜角（PT）、腰椎前凸角（LL）。结果所有患者均获得随访,时间11~23（15.7±2.2）个月。JOA评分：术前为12.2分±1.7分,术后3个月为22.7分±3.1分,末次随访为24.0分±2.8分。VAS评分：术前为8.4分±0.5分,术后3个月为1.9分±0.8分,末次随访为1.8分±0.6分。Cobb角：术前为23.9°±4.2°,术后3个月为3.1°±1.4°,末次随访为3.3°±1.1°。LL：术前为31.6°±5.9°,术后3个月为42.5°±6.6°,末次随访为44.3°±6.0°。PT：术前为21.5°±7.3°,术后3个月为18.9°±9.4°,末次随访为18.5°±7.8°。以上各项指标术后3个月与术前比较差异均有统计学意义（P〈0.05）,末次随访与术后3个月比较差异均无统计学意义（P〉0.05）。结论后路减压内固定植骨融合治疗退变性腰椎侧凸可充分减压,缓解症状,重建腰椎矢状面和冠状面的序列并维持脊柱稳定。

Objective To investigate the clinical efficacy of posterior lumbar interbody fusion（ PLIF） in treatment of degenerative lumbar scoliosis. Methods Nineteen patients with degenerative lumbar scoliosis underwent PLIF. Respectively JOA and VAS was used to evaluate the clinical effects before and after the surgery,imaging studies were performed before and after operation,pelvic tilt（ PT）,lumbar lordosis（ LL） were measured and compared respectively before and after surgery. Results All patients had a follow-up for 11 ~ 23（ 15. 7 ± 2. 2） months. The preoperative JOA score was 12. 2 ± 1. 7,three months after operation,JOA score was 22. 7 ± 3. 1,at the last follow-up,JOA score was 24. 0 ± 2. 8. The preoperative VAS was 8. 4 ± 0. 5,three months after operation,VAS was 1. 9 ± 0. 8,at the last follow-up,VAS was 1. 8 ± 0. 6. The preoperative Cobb angle was 23. 9° ± 4. 2°,three months after operation,Cobb angle was 3. 1° ± 1. 4°,at the last follow-up,Cobb angle was 3. 3° ± 1. 1°. The preoperative LL was31. 6° ± 5. 9°,three months after operation,LL was 42. 5° ± 6. 6°,at the last follow-up,LL was 44. 3° ± 6. 0°. The preoperative PT was 21. 5° ± 7. 3°,three months after operation,PT was 18. 9° ± 9. 4°,at the last follow-up,PT was18. 5° ± 7. 8°. JOA,VAS,Cobb angle,PT,LL showed significantly statistical difference preoperation and postoperation 3 months（ P〈0. 05）,and there was no significant difference in above items between postoperation 3 months and last follow-up（ P〈0. 05）. Conclusions PLIF in the treatment of degenerative lumbar scoliosis can give adequate decompression and alleviation,reconstruct the lumbar sagittal and coronal planes,and maintain the stability of the spine.