非对称截骨治疗老年性退变性腰椎侧后凸畸形

目的：探讨非对称截骨治疗老年性退变性腰椎侧后凸畸形的安全性及有效性。方法：回顾性分析自2010年1月至2012年6月采用非对称截骨手术治疗的17例老年性退变性腰椎侧后凸畸形患者的临床资料，男6例，女11例；平均年龄61岁（57-72岁），术前所有患者拍摄脊柱全长正侧位片，进行矢状面及冠状面平衡分析。术后至少随访1年。对手术前后患者VAS评分、胸腰椎Cobb角及骨盆参数进行分析。结果：17例患者均顺利完成手术，平均手术时间210min（180～260min），术中平均出血量1100ml（750±2200ml）。1年后随访结果显示VAS评分从7．0±1．5下降至1．1±0．6。腰椎前凸从（1．9±9．6）°矫正至（35．2±6．7）°，胸椎后凸从（26．3±9．7）°增加至（32．5±11．2）°；腰椎侧凸Cobb角从（25．1±11．0）°减少至（7．9±3．6）°。骨盆倾斜角（pelvictilt，PT）从（33．0±10．1）°恢复至（25．3±8．9）°，骶骨倾斜角（sacralslope，SS）从（13．9±9．7）。增至（27．2±11．0）°。矢状面平衡从（10．3±8．1）cm恢复至（3．1±4．2）cm。冠状面平衡从（3．5±2．1）cm恢复至（1．3±1．1）cm。结论：非对称截骨手术方式不但可以纠正脊柱侧凸畸形，而且能够重建腰椎前凸，可以安全有效地解决老年性退变性腰椎侧后凸畸形。

Asymmetrical osteotomy for elderly degenerative lumbar kyphoscoliosis

Objective: To investigate the safety and efficacy of asymmetrical osteotomy in treating elderly degenerative lumbar kyphoscoliosis. Methods: From January 2010 to June 2012,17 elder patients with degenerative lumbar kyphoscoliosis were treated with asymmetrical osteotomy,their data were retrospectively analyzed. There were 6 males and 11 females with an average age of 61 years old (57 to 72). Total length spinal X-ray was performed for all patients before operation,and sagittal and coronal balance were analyzed. The follow-up time was 1 year at least. VAS score,thoracolumbar Cobb angle and pelvic parameters were analyzed. Results: All patients were operated successfully. The average operation time was 210 min(180 to 260) and intraoperative blood loss was 1 100 ml (750 to 2 200). At 1 year after operation,VAS score decreased from preoperative 7.0±1.5 to 1.1±0.6; lumbar lordosis (LL) corrected from (1.9±9.6)° to (35.2±6.7)°;thoracic kyphosis (TK) increased from (26.3±9.7)° to (32.5±11.2)°;lumbar scoliosis decreased from (25.1±11.0)° to (7.9±3.6)°;pelvic tilt (PT) restored from (33.0±10.1)° to (25.3±8.9)°;sacral slope (SS) increased from (13.9±9.7)° to (27.2±11.0)°;sagittal balance improved from (10.3±8.1) cm to(3.1±4.2) cm,and coronal balance improved from(3.5±2.1) cm to (1.3±1.1) cm. There was statistically significant difference above data between preoperation and postoperation. Conclusion: Asymmetrical osteotomy can not only correct scoliosis deformity,but also restore lumbar lordosis,and may safely and effectively solve the problem of elderly degenerative lumbar kyphoscoliosis.