延长责任椎短节段固定对退变性腰椎侧凸伴椎管狭窄患者腰椎前凸角的影响及疗效分析

Effects of the prolong vertebra short segment fixation and fusion on lumbar lordosis angle in patients with degenerative lumbar scoliosis and spinal stenosis

目的 探讨延长责任椎短节段固定手术对退变性腰椎侧凸伴椎管狭窄患者腰椎前凸角的影响,分析腰椎前凸角对固定融合节段选择和手术疗效的意义。方法 选取2011年3月至2018年3月退变性腰椎侧凸伴椎管狭窄96例患者接受责任椎固定融合或延长责任椎固定融合治疗的病例资料,按术前腰椎前凸角的不同将患者分为A组(腰椎前凸角>10°)和B组(腰椎前凸角<10°),比较2组中采取责任椎固定融合和延长责任椎短节段固定的腰椎侧凸角、腰椎前凸角、JOA及VAS的改善指数,分析其手术疗效。结果 所有患者获得术后随访至少12个月,最长随访时间61个月,平均17.8个月。A组中57例患者39(68.4%)例行责任椎固定融合,18(31.6%)例行延长责任椎固定融合。配对t检验比较,末次随访VAS、JOA改善指数及JOA改善率差异均无统计学意义(P>0.05);腰椎前凸角和侧凸角改善指数差异有统计学意义(P<0.05)。B组中39例患者12(30.8%)例行责任椎固定融合,27(69.2%)例行延长责任椎固定融合。末次随访VAS、JOA改善指数及JOA改善率差异均有统计学意义(P<0.05);腰椎前凸角和侧凸角改善指数差异有统计学意义(P<0.05)。相关性分析显示,JOA改善率与腰椎前凸角改善指数存在正相关(0<r<1,P<0.05)。可见,根据腰椎前凸角的不同选择不同的固定融合节段可提高手术疗效,其手术疗效与腰椎前凸角的改善有关。结论 延长责任椎短节段固定手术是治疗退行性腰椎侧凸伴椎管狭窄的有效方法,不同腰椎前凸角下选择不同的固定融合节段可提高手术疗效,重视腰椎前凸角对固定融合节段选择的影响具有一定的临床意义。

Objective To investigate the effects of the prolong vertebra short segment fixation and fusion on lumbar lordosis angle in patients with degenerative lumbar scoliosis and spinal stenosis,and to analyze the significance of lumbar lordosis angle in the selection of instrumented fusion segment and surgcal treatment. Methods The clinical data of 96 patients with degenerative lumbar scoliosis complicated by spinal stenosis who underwent relevant vertebrae decompression and instrumented fusion or prolong instrumented fusion were retrospectively analysed.The patients were divided into group A (lumbar lordosis angle >10°) and group B (lumbar lordosis angle <10°) according to the difference of lumbar lordosis angle.The lumbar lordosis angle,lumbar scoliosis angle,JOA and VAS were observed and compared between the two groups.Results All the patients were followed up for 12~61 months (average 17.8 months).Among the 57 patients in group A,39 cases (68.4%) underwent routine responsibility vertebra fixed fusion,and 18 cases (31.6%) underwent extended responsibility vertebral fusion fixed routine. There were no significant differences in VAS,JOA improvement index and JOA variation in the last follow up (P>0.05),however,there were significant differences in the improvement indexes of the anterior convex angle and lateral convex angle of the lumbar vertebrae (P<0.05).Of the 39 patients in group B,12 cases (30.8%) underwent routine responsibility vertebra fixed fusion,and 27 cases (69.2%) underwent extended responsibility vertebral fusion fixed routine.There were significant differences in the VAS,JOA improvement indexes and JOA variation in last follow up (P<0.05),moreover,there were significant differences in the improvement indexes of the anterior convex angle and lateral convex angle of the lumbar vertebrae.The correlation analysis showed that the improvement rate of JOA was related to the improvement indexes of lumbar lordosis angle (P<0.05).Conclusion It is an effective method to treat degenerative lumbar scoliosis complicated by spinal stenosis by relevant vertebrae decompression and prolong instrumented fusion.The selection of different fixed fusion segments according to different lumbar lordosis angle can improve the clinical curative effects and has important clinical significance.