局限减压结合内固定融合治疗退变性腰椎侧凸

目的探讨应用局限神经减压,椎弓根螺钉系统固定加后外侧植骨融合治疗退变性腰椎侧凸的疗效。方法回顾性分析45例退变性腰椎侧凸患者的临床特点,探讨手术适应证和禁忌证,采用局限神经减压、椎弓根螺钉系统内固定和后外侧植骨融合的术式治疗,分析手术效果和并发症,总结术中及术后注意事项,同时对减压和固定融合范围、融合方式等进行探索。结果术后随访24~46个月(平均32个月),临床疗效采用Suk标准评定,植骨融合率88.9%,优良率为93.3%。脑脊液漏1例,神经并发症3例,内固定松动、断裂1例,肺部感染1例,肺栓塞死亡1例。结论采用腰椎管局限神经减压,椎弓根螺钉钉棒系统固定加后外侧植骨融合是治疗退变性腰椎侧凸安全有效的方法,但应严格掌握手术适应证和禁忌证,减压要彻底,但范围不宜过大。

Treatment of Limited Neural Decompression Combined with Instrumented Fusion for Degenerative Lumbar Scoliosis

Objective To study clinical efficacy of limited neural decompression combined with fixation of pedicle screw system and posterolateral fusion for degenerative lumbar scoliosis. Methods To analyze clinical outcome of 45 patients of degenerative lumbar scoliosis retrospectively. Operative indication and contraindication were investigated. Limied neural decom- pression combined with fixation of pedicle screw system and posterolateral fusion were performed in the patients. Treatment effect and postoperative complication were analyzed. Matters needing attention of intraoperation and postoperation were summarized. Meanwhile,the range of neural decompression and fixation and methods of fusion were discussed. Results Time of follow-up after operation were 12 -48 months with an average of 22 months. According to Suk＇scriteria, Fusion rate was 98.9%. Adopting JOA scriteria about back pain to evaluate the clinical efficacy, the excellent and good rate was 93.3%. Nerval complication in 3 cases. Leakage of cerebrospinal in 1 case. Loosening and breakaged of instrument in 1 case. lcase died of pulmonary embolism. Conclusion Limited neveral decompression combined with pedicle screw system fixation and spinal posterolateral fusion are effective and safe treatment for degenerative lumbar scoliosis. Operative treatment should be contemplated after multi-factorial and multidisciplinary evaluation of the risks and the benefits. Meanwhile, the indication and contraindication should be oberseved. Neural decompression should be thoroughgoing, but limited.