腰椎退行性侧凸畸形的手术治疗策略

Surgical strategy for degenerative lumbar scoliosis in elderly patients

目的探讨腰椎退行性侧凸畸形的手术策略及疗效。方法回顾性分析自2009-02—2014-02采用责任节段减压、选择性固定融合治疗的93例腰椎退行性侧凸畸形。比较术前及末次随访时腰痛VAS评分、腿痛VAS评分、ODI指数、JOA评分、侧凸Cobb角、前凸Cobb角。结果本组手术时间115~189(147.87±24.51)min,术中出血量210~730(357.33±27.44)ml,术后引流量230~550(441.39±31.39)ml。4例因椎管狭窄及粘连严重术后出现脑脊液漏,经头低足高位治疗,切口均一期愈合。3例切口积血,延期3~5 d愈合。93例均获得随访16~63个月,平均54.1个月。末次随访时患者腰痛VAS评分、腿痛VAS评分、ODI指数、JOA评分、侧凸Cobb角、前凸Cobb角均较术前明显改善,差异有统计学意义(P<0.05)。结论责任节段减压、选择性固定融合治疗腰椎退行性侧凸畸形效果良好,但手术既要达到治疗目的,又要减少脊柱结构单元的破坏,更要兼顾术后是否会并发邻近节段退变、侧凸畸形进一步加重等问题。

Objective To assess the efficacy of a new surgical strategy for lumbar degenerative scoliosis. Methods From February 2009 to February 2014, 93 cases of degenerative lumbar scoliosis underwent selective segmental fusion with decompression of responsible segment. VAS, JOA, ODI, lumbar lordosis Cobb angle and lumbar scoliosis Cobb angle were compared before and after surgery. Results The operation time was 115-189 min（147.87±24.51）miu. There were 210-730 ml （357.33±27.44）ml blood loss during surgery and 230-550 ml （441.39±31.39）ml during postoperative drainage. Four patients had cerebrospinal fluid leakage due to spinal stenosis and adhesion, whose wound was healed by Trendelenburg position treatment. Three cases suffered wound hematoma and healed with a delay of 3-5 days. All the patients were followed up for 54.1 （16-63）months. There were statistical differences in VAS, ODI, JOA, lumbar lordosis Cobb and lumbar scoliosis Cobb angle before and after surgery （P 〈0.05）. Conclusion Satisfactory results could be acquired when degenerative scoliosis is treated with selective segmental pedicle screw fixation with decompression of responsible segment. The surgery can rectify the scoliosis and avoid massive destruction of the spinal column, which could prevent spine adjacent segmental degeneration and further scoliosis.