退变性腰椎侧凸的手术治疗进展

Research progress on surgical treatment for degenerative lumbar scoliosis

目的探讨退变性腰椎侧凸的手术治疗进展。方法在PubMed和中国知网数据库,限定语言种类为English和中文,检索1970年1月—2021年7月发表的有关退变性腰椎侧凸手术治疗的文献1638篇,根据纳入、排除标准进行筛选,最终纳入45篇文献(中文6篇、英文39篇)。从手术固定融合范围、长节段固定融合上下端椎的选择、微创技术以及围手术期并发症4个方面进行总结分析。结果对于矢状位平衡尚可的相对年轻且术后运动功能要求较高的退变性腰椎侧凸患者、身体条件差无法耐受全身麻醉和大手术的退变性腰椎侧凸患者、宽/长指数小于0.36的退变性腰椎侧凸患者,采取有限减压、固定、融合手术是可行的。对于严重或进展较快的矢状位和/或冠状位失平衡、旋转畸形、腰椎滑脱或不稳的僵硬性退变性腰椎侧凸患者,开放手术长节段固定融合是必要的,合并发生腰椎后凸者还需要考虑进行截骨。对于接受长节段固定融合手术的退变性侧凸患者,上、下端椎的选择要遵循个体化原则。目前退变性腰椎侧凸微创治疗多为单中心报道,疗效满意,但是微创技术并不适用于所有退变性腰椎侧凸患者,长期疗效以及翻修情况有待于今后的继续观察。结论尽管退变性腰椎侧凸的治疗手段越来越多元化且临床疗效确切,但患者的治疗仍然需要遵循个体化原则。手术治疗以改善患者的临床症状和提高综合满意度为首要原则,适当重建冠状位和矢状位的平衡,以尽可能小的手术创伤取得最佳的临床疗效。微创技术的快速发展为退变性腰椎侧凸的手术治疗增添了新的选择,其短期疗效确切,长期疗效还有待随访观察。

Objective To explore the research progress on surgical treatment for degenerative lumbar scoliosis.Methods A computer-based online search of PubMed and CNKI databases was undertaken to identify articles about"surgical treatment for degenerative lumbar scoliosis"published in Chinese or English from January 1970 to July 2021.Forty-five articles were finally included(six articles in Chinese and 39 articles in English)from the 1638 articles identified after considering the inclusion and exclusion criteria.We summarized the points in four aspects:the range of surgical fusion,the choice of long-segment fusion,minimally invasive techniques,and perioperative complications.Results Limited decompression and fixation are suggested for patients with acceptable sagittal balance,young patients,patients with functional requirements,patients with poor physical conditions who cannot undergo general anesthesia,and patients with a width/length index less than 0.36.Open surgery with long-segment fixation and fusion is necessary for patients with severe or rapidly progressing sagittal and/or coronal imbalance,rotational deformity,lumbar spondylolisthesis,or instability with rigid degenerative scoliosis.For patients with degenerative scoliosis undergoing long-segment fixation and fusion surgery,the choice of upper and lower vertebrae should follow the principle of individualization.At present,most of the minimally invasive treatments for degenerative scoliosis are reported by single centers.Although the curative effect is satisfactory,minimally invasive technique is not suitable for all patients with degenerative scoliosis.The long-term curative effect of revision surgery needs to be observed in the future.Conclusion Although the treatment methods for degenerative lumbar scoliosis are diversified,the main principle is individualization.Surgical plan should consider patient's general condition,imaging characteristics,clinical symptoms,and habits of the surgeon.The primary principle is relief of the clinical symptoms at the low cost of surgical trauma.The rapid development of minimally invasive technology has added new options for the surgical treatment of degenerative scoliosis.However,long-term follow-up observation is needed to evaluate their therapeutic effects.