后路经椎弓根侧方旋转复位技术治疗退行性腰椎侧凸的临床应用

Clinical Efficacy of Posterior Transpedicular Lateral Rotatory Reductionin Intreatment of Degenerative Lumbar Scoliosis

目的探讨后路经椎弓根侧方旋转复位技术治疗退行性腰椎侧凸(degenerative lumbar scoliosis,DLS)的临床疗效。方法 2013年1月至2016年1月,实施后路经椎弓根侧方旋转复位、椎体间融合、椎弓根系统内固定术治疗退行性腰椎侧凸患者21例。回顾分析临床资料,观察比较术前、术后及末次随访Oswestry功能障碍指数(oswestry disability index,ODI)、日本矫形外科协会下腰痛评分(Japanese orthopaedic association scores,JOA)、顶椎旋转角度、腰椎前凸角及侧凸Cobb角变化情况,综合评定术后疗效。结果 21例患者均顺利完成手术。术后并发L4神经根损伤1例,经对症及康复治疗后好转。所有患者获得随访8~28个月,平均(18.0±1.5)个月。腰背痛、下肢痛、神经源性跛行均明显改善。术前ODI平均(39.1±8.0)分,末次随访ODI平均(15.2±2.2)分,较术前明显降低(P<0.05);术前JOA平均(11.5±2.3)分,末次随访JOA平均(25.4±1.3)分,较术前明显增高(P<0.05);顶椎旋转角度从术前(17.5±2.2)°恢复到(6.4±1.7)°,腰椎前凸角从(10.6±2.7)°增加到(26.3±1.5)°,侧凸Cobb角从(28.6±2.5)°减少到(8.7±1.3)°。随访期间无内固定松动、移位及断钉。结论采用后路经椎弓根侧方旋转复位技术,结合后路减压、椎体间植骨、椎弓根螺钉内固定治疗退行性腰椎侧凸可有效矫正腰椎侧凸,恢复腰椎前凸,临床疗效满意。

Objective To investigate the clinical efficacy of posterior transpedicular lateral rotatory reduction in treatment of degenerative lumbar scoliosis（DLS）.Methods 21 patients of DLS received posterior transpedicular lateral rotatory reduction,interbody fusion and internal fixation of pedicle system treatment from January 2013 to January 2016.All patients were followed up for 8 to 28 months with an average of（18.0±1.5）months.We retrospectively analyzedthe clinical materials,changes of oswestry disability index（ODI）,Japanese orthopaedic association scores（JOA）,apical vertebral rotation,lumbar lordotic angle and scoliosis Cobb angle pre-operationand post-operation were evaluated comprehensively.Results All patients underwent the operation successfully.One patient suffered from L4 neural root lesion after the operation but relieved after treatment and rehabilitation.Low back pain,lower limb pain,and neurogenic claudication improved significantly.Preoperative ODI was（39.1±8.0）on average and（15.2±2.2）for the last follow-up,which were obviously reduced compared to that before the surgery（P〈0.05）.Preoperative JOA was（11.5±2.3）on average and（25.4±1.3）for the last follow-up,which were significantly increased compared to that before the surgery（P〈0.05）.Apical vertebral rotation was corrected to（6.4±1.7）°from preoperative（17.5±2.2）°.Lumbar lordotic angle increased from（10.6±2.7）°to（26.3±1.5）°and scoliosis Cobb angle was reduced from（28.6±2.5）°to（8.7±1.3）°.Internal fixation loosening,rotation and breakage were not seen during follow-up.Conclusion After adoption of posterior transpedicular lateral rotatory reduction in combination with posterior decompression,interbody bone grafting and pedicle screw internal fixation in treating DLScan effectively correct lumbar scoliosis and recover lumbar lordosis,with satisfactory clinical efficacy.