一期后入路椎间松解Cage植入联合SchwabⅠ级截骨术治疗退变性腰椎侧弯疗效分析

Treatment of degenerative lumbar scoliosis by one-stage posterior interbody release Cage implantation combined with Schwab gradeⅠosteotomy

目的:探讨一期后入路椎间松解Cage植入联合SchwabⅠ级截骨术对退变性腰椎侧弯的手术疗效分析。方法:对2016年1月至2021年6月脊柱外科收治并手术治疗的退变性腰椎侧弯的患者42例进行回顾性研究。其中男14例,女28例,年龄(62.14±7.85)岁,患者均行一期后入路椎间松解Cage植入联合SchwabⅠ级截骨术,详细记录患者围手术期神经功能评定、手术时间、术中出血量及术后并发症等情况。术后随访6~24个月,所有患者术前、术后及末次随访时应用健康调查问卷简化版(SF-36),Oswestry功能障碍指数问卷表(ODI)、疼痛视觉模拟评分(VAS)评估临床疗效。对比分析患者手术前后脊柱骨盆的影像学参数的改变,包括术前、术后、末次随访时侧弯的Cobb角,矢状面平衡(SVA)、冠状面平衡(CBD)、骨盆入射角与腰椎前凸角的匹配度(PI-LL)、双肩高度差。结果:术中1例患者出现硬脊膜损伤,余未出现术中及术后并发症,末次随访时ODI、VAS评分均较术前显著降低(t=-5.56、-5.70,均P<0.001),SF-36生理功能总分和心理功能总分较术前显著增高(t=-25.15、-10.6,均P<0.05)。影像参数方面,患者术前Cobb角为(24.11±1.36)°,末次随访时为(5.04±1.70)°,末次随访时Cobb角显著下降(t=-6.62,P<0.001),平均侧弯矫形率为79.09%,末次随访时SVA(t=-3.23,P<0.05)及CBD(t=-4.59,P<0.001)、双肩高度差(t=-5.49,P<0.001)、PI-LL(t=-5.27,P<0.001)较术前差异有统计学意义。所有患者在随访期间均未出现断钉断棒现象。结论:一期后入路椎间松解Cage植入联合SchwabⅠ级截骨术对退变性腰椎侧弯有明确的疗效,可以较好的重建并维持患者矢状面及冠状面平衡。

Objective:To investigate the efficacy of one-stage posterior interbody release Cage implantation combined with Schwab gradeⅠosteotomy in the treatment of degenerative lumbar scoliosis.Methods:A retrospective study was performed on 42 patients with degenerative lumbar scoliosis who were admitted to the spinal surgery department of our hospital from January 2016 to June 2021.There were 14 males and 28 females,aged(62.14±7.85).All 42 patients underwent one-stage posterior interbody Cage fusion internal fixation combined with Schwab gradeⅠosteotomy.Perioperative neurological function assessment,operative time,intraoperative blood loss and postoperative complications were recorded in detail.Patients were followed up for 6 to 24 months.All patients were treated with the simplified health Questionnaire(SF-36)before,after,and at the last follow-up.The Oswestry Disability Index(ODI)and visual analogue scale(VAS)were used to assess clinical outcomes.The changes of spinal and pelvic imaging parameters before and after surgery were compared,including the Cobb angle of lateral curvature,before,after and at the last follow-up.Sagittal sagittal vertical axis(SVA),coronal balance distance(CBD),pelvic incidence angle and lumbar lordosis angle matching(PI-LL),shoulder height difference before,after and at the last follow-up.Results:All 42 patients successfully completed the operation,1 patient developed dural injury during the operation,and no intraoperative or postoperative complications occurred in the remaining patients.ODI and VAS scores were significantly lower after the operation and at the last follow-up than before the operation(t=-5.56,-5.70,both P<0.001).The total physical and mental functioning scores of SF-36 were significantly higher than those before surgery(t=-25.15,-10.6,both P<0.05).In terms of image parameters,the Cobb angle of the patient was(24.11±1.36)°before surgery,and(5.04±1.70)°at the last follow-up.The Cobb angle decreased significantly at the last follow-up(t=-6.62,P<0.001),and the average lateral bending correction rate was 79.09%.There were significant differences in SVA(t=-3.23,P<0.05),CBD(t=-4.59,P<0.001),shoulder height difference(t=-5.49,P<0.001),PI-LL(t=-5.27,P<0.001)at the last follow-up.None of the patients had broken screw or rod during the follow-up period.Conclusion:One-stage posterior Cage implantation combined with Schwab gradeⅠosteotomy is effective in the treatment of degenerative lumbar scoliosis,and can reconstruct and maintain sagittal and coronal balance in patients.