退行性脊柱侧凸的Lenke-Silva分型及手术方法的选择

Lenke-Silva classification of degenerative scoliosis and its selection of surgical treatment methods

目的探讨退行性脊柱侧凸的Lenke-Silva分型及其指导临床治疗的意义。方法回顾性分析自2016-01—2019-07诊治的35例退行性脊柱侧凸,损伤按Lenke-Silva分型:Ⅰ型2例,Ⅱ型10例,Ⅲ型11例,Ⅳ型7例,Ⅴ型3例,Ⅵ型2例。Ⅰ型只需要进行减压处理;Ⅱ~Ⅳ型需要行减压联合短节段固定,矫正冠状面侧凸及腰椎后凸畸形;Ⅴ型与Ⅵ型需要行减压联合长节段固定,矫正矢状面及冠状面的失衡,必要时需截骨矫形。比较术前、术后3个月及末次随访时疼痛VAS评分、ODI指数、伤椎Cobb角、腰椎前凸角(Lumbar lordosis,LL)、骨盆倾斜角(Pelvic tilt,PT)、骨盆入射角(Pelvic incidence,PI)与LL的差值。结果 35例均顺利完成手术并获得完整随访,随访时间8~24个月,平均15个月。术后1例出现脑脊液漏,1例出现肺部感染,1例出现下肢静脉血栓,均经对症治疗后治愈。术后3个月及末次随访时疼痛VAS评分、ODI指数、伤椎Cobb角、PT、PI与LL差值较术前减小,LL较术前增大,差异有统计学意义(P<0.05)。结论 Lenke-Silva分型指导退行性脊柱侧凸的治疗可取得满意的临床疗效,此分型可信度高,重复性好,临床实用性高,值得推广应用。

Objective To explore the Lenke-Silva classification of degenerative scoliosis and its significance in guiding clinical treatment.MethodsRetrospective analysis of 35 cases of degenerative scoliosis was diagnosed and treated from January2016 to July 2019. The degenerative scoliosis were classified according to Lenke-Silva classification: 2 cases of type Ⅰ, 10 cases of type Ⅱ, 11 cases of type Ⅲ, 7 cases of type Ⅳ, 3 cases of type Ⅴ, 2 cases of type Ⅵ. Type Ⅰ only required decompression treatment;Type Ⅱ-Ⅳ required decompression combined with short-segment fixation to correct coronal scoliosis and lumbar kyphosis;Type Ⅴ and Ⅵ required decompression combined with long-segment fixation for correcting the imbalance of the sagittal and coronal planes required osteotomy if necessary. The pain VAS score, ODI index, Cobb angle of injured vertebrae,lumbar lordosis(LL), pelvic tilt angle(PT), the difference between pelvic incidence(PI) and LL were compared.ResultsAll the 35 cases successfully completed the operation and received comprehensive follow-up. The follow-up time was 8-24 months, with an average of 15 months. One case developed, cerebrospinal fluid leakage, 1 case developed pulmonary infection,1 case developed lower extremity venous thrombosis, all were cured after symptomatic treatment. The difference between pain VAS score, ODI index, Cobb angle of injured vertebra, PT, the difference between PI and LL at 3 months after operation and at the last follow-up decreased compared with that before operation, while LL increased compared with that before operation. The difference was statistically significant(P<0.05).ConclusionThe Lenke-Silva classification may guide the treatment of degenerative scoliosis and can achieve satisfactory clinical effects. This classification has high reliability, good reproducibility, and high clinical practicability, and can be worth popularizing in clinical practice.