后路有限减压短节段固定融合手术治疗腰椎退行性侧凸的临床疗效评价

Clinical evaluation of posterior limited decompression,short segment fixation and fusion surgery in treatment of lumbar degenerative scoliosis

目的评价后路有限减压、短节段固定及融合手术治疗腰椎退行性侧凸的临床疗效。方法收集2012-12~2014-08该院收治腰椎退行性侧凸患者22例。所有患者术前行X线、CT及MRI检查,均采用有限减压、短节段固定及融合手术进行治疗。术后随访,采用疼痛视觉模拟量表(VAS)、Oswestry功能障碍指数(ODI)评分系统进行疗效评估。结果所有患者均获得随访,随访时间为24~60个月,平均34.8个月。手术时间78~208 min,平均138.5 min;出血量250~1000 ml,平均433 ml。患者术后末次随访平均Cobb角(17.83±11.38)°,腰椎前凸角(37.04±15.27)°,矢状位平衡(36.99±31.20)mm,与术前比较差异有统计学意义(P<0.05);术后末次随访腰部VAS评分为(1.73±1.52)分,腿部VAS评分(1.59±0.67)分,ODI评分(12.82±3.08)分,均较术前降低,差异有统计学意义(P<0.01)。术后发生肺部感染l例,出现伤口深部感染1例,无一例发生腰椎侧凸进展、椎间隙塌陷、神经损伤及钉棒断裂等并发症。结论后路有限减压、短节段固定及融合手术是治疗腰椎退行性侧凸的有效手段。

Objective To evaluate the clinical effects of posterior limited decompression,short segment fixation and fusion surgery on lumbar degenerative scoliosis.Methods Twenty-two patients with lumbar degenerative scoliosis admitted to our hospital from December 2012 to August 2014 were collected.All the patients underwent preoperative X-ray,computed tomography(CT)and magnetic resonance imaging(MRI)examinations,and were treated with posterior limited decompression,short segment fixation and fusion surgery.The patients were followed up and Visual Analogue Scale(VAS)and Oswestry Disability Index(ODI)scoring systems were used to evaluate the therapeutic effects.Results All the patients were followed up for 24~60 months,with an average of 34.8 months.The operation time was 78~208 min,with an average of 138.5 min,and the bleeding volume was 250~1000 ml,with an average of 433 ml.At the last follow-up after surgery,the mean Cobb′s angle(17.83±11.38)°,lumbar lordosis angle(37.04±15.27)°,sagittal vertical axisc(SVA)(36.99±31.20)mm were all significantly different from those before surgery(P<0.05).At the last follow-up after surgery,the VAS scores of the waist(1.73±1.52)points,the VAS scores of the legs(1.59±0.67)points and the ODI scores(12.82±3.08)points were significantly lower than those before surgery(P<0.01).Postoperative pulmonary infection occurred in 1 case,deep wound infection in 1 case,and no complications such as progression of lumbar scoliosis,intervertebral space collapse,nerve injury and failure of the internal fixation system occurred.Conclusion Posterior limited decompression,short segment fixation and fusion surgery are an effective method for treatment of lumbar degenerative scoliosis.