短节段固定融合治疗老年人群的腰椎滑脱并脊柱侧凸

Responsible segment decompression and short fusion with internal fixation for elderly patients with degenerative lumbar spondylolisthesis and scoliosis

目的探讨责任节段减压、短节段融合内固定治疗老年人群退变性腰椎滑脱并脊柱侧凸的疗效。方法回顾性分析2013年1月~2016年12月通过选择性神经根阻滞术确认责任节段,采用责任节段减压、短节段融合内固定治疗的35例退变性腰椎滑脱并脊柱侧凸患者(男13例,女22例,平均66.83±4.4岁)。比较治疗前后的VAS评分、ODI指数、Cobb角。结果35例均完成手术并获得随访,手术减压1.51(1~2)个节段,平均随访44.09(25~60)个月。术前腰痛VAS评分平均(5.43±1.14)分,下肢痛(5.51±1.46)分,ODI指数(58.11±13.13)%;末次随访腰痛VAS评分平均(1.14±0.91)分,下肢痛(0.94±0.76)分,ODI指数(25.86±11.13)%。术前与术后比较,具有统计学差异(P<0.05)。术前Cobb角为平均(20.63±5.44)°,末次随访为(17.00±5.28)°,差异有统计学意义(P<0.05)。结论责任节段减压配合短节段融合内固定手术治疗老年人群的退变性腰椎滑脱并脊柱侧凸,减轻疼痛、恢复躯体功能的疗效肯定,也存在一定的侧凸矫正作用。

Objective To evaluate the effect of responsible segment decompression and short fusion with internal fixation for elderly patients with degenerative lumbar spondylolisthesis and scoliosis.Methods After selective nerve root block to confirm the responsible segment,35 patients[13 males,22 females,average(66.83±4.4)years old]with degenerative lumbar spondylolisthesis and scoliosis were treated with responsible segment decompression and short fusion with internal fixation from January 2013 to December 2016.The visual analogue scale(VAS),Oswestry disability index(ODI)and Cobb angle were compared before and after treatment.Results All 35 patients underwent surgeries and were followed up.The average decompression segment was 1.51(1~2)segments,and the average follow-up duration was 44.09(25-60)months.Before operation,the mean VAS of low back pain was(5.43±1.14),the lower extremity pain was(5.51±1.46),and the ODI was(58.11±13.13)%.At the final follow-up,the mean VAS of low back pain was(1.14±0.91),the lower extremity pain was(0.94±0.76),and the ODI was(25.86±11.13)%.There were statistically significant differences compared with preoperation(P<0.05).The preoperative mean Cobb angle was(20.63±5.44)°,and the postoperative Cobb angle at the last follow-up was(17.00±5.28)°,the difference was statistically significant(P<0.05).Conclusion Responsible segment decompression combined with short fusion with internal fixation in the treatment of elderly patients with degenerative lumbar spondylolisthesis and scoliosis is effective in reducing pain and restoring physical function in mid-to long-term follow up,which also helps correct spinal deformity finitely.