矢状面有限矫形治疗老年退变性脊柱侧凸

Limited correction of sagittal spinal alignment for elderly degenerative scoliosis

目的 探讨矢状面有限矫形策略治疗老年退变性脊柱侧凸（DS）的可行性。方法 回顾分析2012年7月至2013年7月期间解放军总医院骨科接受脊柱手术的37例老年DS患者的临床资料。根据术后脊柱矢状面腰椎前凸角（LL）恢复程度将患者分为两组：矢状面有限矫形组［骨盆入射角（PI）－18°≤术后LL＜PI－9°，n＝20］和对照组（PI－9°≤术后LL≤PI＋9°，n＝17）。对比分析两组患者的术后影像学参数及临床功能疼痛评分。结果 与对照组患者相比，矢状面有限矫形组患者的出血量减少（P＝0.07）、手术时间缩短（P＝0.09），但差异尚无统计学意义。两组患者术后的LL、骨盆倾斜角（PT）和骶骨倾斜角（SS）间存在显著性差异（P＜0.05），而腰椎侧凸Cobb角、 Oswestry功能障碍评分及日本矫形外科协会（JOA）下腰痛评分等指标间的差异无统计学意义（P＞0.05）。结论 矢状面有限矫形策略应用于老年DS患者，在冠状面矫形、Oswestry功能障碍评分及JOA下腰痛评分方面可同样获得良好的临床效果。

Objective To explore the feasibility of limited correction for sagittal spinal alignment in the elderly with degeneratve scoliosis （DS）. Methods Clinical data of 37 elderly DS patients who underwent spinal surgery in the Chinese PLA General Hospital from July 2012 to July 2013 were collected in this retrospective study. According to the recovery of postoperative lumbar lordosis （LL）, the patients were divided into the limited-correction group [pelvic incidence （PI） -18°≤ postoperative LL〈PI-9°, n=20], and the control group （PI-9°≤postoperative LL〈PI＋9°, n=17）. The radiographic parameters and functional and pain scores were compared between the 2 groups. Results The limited correction group had smaller blooding volume （P=0.07） and shorter operation time （P=0.07） when compared with the control group, though the difference has no statistical significance. There were significant differences in the LL, pelvic tilt （PT）, and sacral slope （SS） between the 2 groups postoperatively （P〈0.05）, but not in lumbar coronal Cobb angle, Oswestry low back pain score and Japanese Orthopedic Association （JOA） score （P〉0.05）. Conclusion Limited correction for sagittal spinal alignment is an effective approach for the elderly DS patients, and achieves good clinical outcomes in lumbar coronal Cobb angle, coronal correction, Oswestry score and JOA score.