短节段固定治疗老年退行性脊柱侧凸合并腰椎管狭窄的临床疗效

Clinical effect of short-segment fixation for degenerative scoliosis with lumbar stenosis in the elderly

目的评估短节段减压固定术治疗老年退行性脊柱侧凸合并腰椎管狭窄的临床疗效。方法回顾性分析2014年1月至2017年12月,我院采用后路短节段(<3节段)固定融合手术治疗的59例老年(>65岁)退行性脊柱侧凸合并腰椎管狭窄患者,根据Berjano分型分为Ⅰ型组(40例)和Ⅱ型组(19例)。患者年龄65~88岁,平均75.4岁,随访时间18~36个月,平均25.1个月。记录患者手术时间、术中失血量、术后并发症的发生情况,评估两组患者术前、术后随访时腰部和下肢的疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI),比较术前和术后随访时患者侧凸Cobb’s角、脊柱矢状位平衡(sagittal vertical axis,SVA)和腰椎前凸角(lumbar lordosis,LL)的变化情况。结果两组患者年龄、性别、随访时间、术前神经根阻滞患者数、手术时间、术中失血量差异均无统计学意义(P>0.05),组间手术节段差异有统计学意义(χ2=5.09,P=0.02)。末次随访时两组患者腰部和下肢VAS以及ODI均较术前明显改善,差异有统计学意义(P<0.05),组间差异无统计学意义(P>0.05)。BerjanoⅠ型和Ⅱ型患者侧凸Cobb’s角分别由术前的(17.2±3.5)°和(19.1±4.2)°降至术后3个月时的(10.3±2.7)°和(10.5±3.1)°,而末次随访时分别增加至(14.3±2.9)°和(15.2±3.9)°,与术前相比差异均有统计学意义(FⅠ=51.5,P<0.01;FⅡ=25.5,P<0.01),而SVA和LL术前、术后无显著变化(P>0.05)。两组共有20例(33.9%)出现并发症,其中围术期并发症15例,远期并发症5例,两组间差异无统计学意义(P>0.05)。结论短节段减压固定手术治疗BerjanoⅠ型和Ⅱ型老年退行性脊柱侧凸合并腰椎管狭窄,具有满意的短期临床疗效,能够改善侧凸畸形。

Objective To evaluate the clinical effect of short-segment decompression and fixation for degenerative scoliosis with lumbar stenosis in elderly patients.Methods From January 2014 to December 2017,clinical data of 59 patients over 65 years old who underwent posterior lumbar short-segment (< 3) decompression and fixation in our hospital due to degenerative scoliosis with lumbar stenosis were retrospectively analyzed.All were divided into type Ⅰ group (40 cases) and type Ⅱ group (19 cases) according to Berjano classification.The average age was 75.4 years (range:65-88 years).The mean follow-up was 25.1 months (range:18-36 months).Operation time,intraoperative blood loss,and postoperative complications were recorded.Visual analogue scale (VAS) and Oswestry disability index (ODI) of the lumbar and lower limb,Cobb’s angle,sagittal vertical axis (SVA) and lumbar lordosis(LL) were compared preoperatively and postoperatively.Results There were no statistically significant differences in age,gender,follow-up time,number of patients with preoperative nerve root block,operation time,and intraoperative blood loss between the two groups (P > 0.05),but the differences in surgical segments were statistically significant between the two groups (χ~2=5.09,P=0.02).At the final follow-up,the lumbar and lower limb VAS and ODI of the two groups were significantly improved compared to that preoperatively (P < 0.05),and the differences between the two groups were not statistically significant (P > 0.05).The scoliosis Cobb’s angle in patients with Berjano type Ⅰ and type Ⅱ decreased from (17.2±3.5) ° and (19.1±4.2) ° preoperatively to (10.3±2.7) ° and (10.5±3.1) 3 months after surgery,but increased to (14.3±2.9) ° and (15.2±3.9) ° at the final follow-up with statistical significance (F_Ⅰ=51.5,P < 0.01;F_Ⅱ=25.5,P < 0.01).SVA and LL showed no significant changes before and after surgery (P > 0.05).Complications occurred in 20 patients (33.9%),including 15 perioperative complications and 5 long-term complications.However,no significant differences were noted between the two groups(P > 0.05).Conclusions Short-segment decompression and fixation have satisfactory short-term clinical effects in the treatment of Berjano type Ⅰ and type Ⅱ degenerative scoliosis with lumbar stenosis and scoliosis improvement in elderly patients.