退行性腰椎侧凸合并椎管狭窄症的手术治疗

目的:探讨后路有限减压、固定、融合手术治疗退行性腰椎侧凸合并椎管狭窄症的疗效。方法:2002年6月至2009年1月,收治退行性腰椎侧凸合并椎管狭窄症患者26例,男6例,女20例;年龄51～72岁,平均61.3岁;合并椎管狭窄症病程11个月～6年,平均36个月。所有患者术前均行X线、CT及MRI检查,6例患者行脊髓造影检查,术前Cobb角为(22.0±10.1)°,腰椎前凸角为(21.6±10.2)°,C7铅垂线(C7PL)与S1椎体后上缘距离(SVA)为(7.6±6.4)cm,C7PL与骶正中线距离(CSVL)为(6.8±5.6)cm。采用后路有限减压、固定、融合手术进行治疗,术后进行随访。术后及末次随访时测量Cobb角、腰椎前凸角、SVA、CSVL并与术前进行比较;采用腰痛JOA评分系统进行疗效评估。结果:手术时间110～185min,平均140min;出血量480～850ml,平均620ml。所有患者获得随访,时间1.3～5年,平均2.5年。患者术后及末次随访时的Cobb角分别为(10.5±8.2)°、(8.8±5.2)°,腰椎前凸角分别为(25.4±14.2)°、(31.6±13.2)°,SVA分别为(0.6±3.3)cm、(-1.2±2.5)cm,CSVL分别为(2.8±1.3)cm、(1.6±1.2)cm,较术前均有明显改善。JOA评分:术前(11.0±1.7)分,术后即刻(22.4±2.4)分,末次随访时(24.0±2.1)分,结果:优13例,良8例,可3例,差2例。术后1例患者发生矫正丢失,无椎间隙塌陷、神经损伤、钉棒断裂等并发症。结论:后路有限减压、固定、融合手术是治疗退行性腰椎侧凸合并椎管狭窄症的有效手段。

Surgical treatment of degenerative lumbar scoliosis with spinal stenosis

Objective: To investigate the clinical effects of limited decomression,fixation,and fusion in treating degenerative scoliosis with spinal stennosis. Methods: From June 2002 to January 2009,26 patients of degenerative scoliosis with spinal stenosis were treated with limited decomression,fixation,and fusion. There were 6 males and 20 females with an average age of 61.3 years (ranged,51 to 72 years). Course of disease of spinal stenosis was from 11 months to 6 years with an average of 36 months. X-ray,CT,MRI examination were performed preoperatively for all the cases and myelography was performed for 6 cases. Preoperative Cobb's angle,focal lordosis angle,the distance between C₇ plumb line(C₇PL) and upper edge of S₁ vertebral body (SVA),and the distance between C₇PL and center sacral vertical line (CSVL) were (22.0±10.1)°,(21.6±10.2)°,(7.6±6.4) cm,(6.8±5.6) cm respectively. Measured Cobb's angle,focal lordosis angle,SVA,CSVL after operation and final follow-up were compared with preoperative data. JOA score system were used to evaluate clinical effects. Results: The operative time was from 110 to 185 min with an average of 140 min;volume of blood loss was from 480 to 850 ml with an average of 620 ml. All the patients were followed up from 1.3 to 5 years with an average of 2.5 years. Postoperative and final follow-up,Cobb's angle was (10.5±8.2)°,(8.8±5.2)°,respectively;focal lordosis angle was(25.4±14.2)°,(31.6±13.2)°,respectively; SVA was (0.6±3.3) cm,(-1.2±2.5) cm,respectively;CSVL was(2.8±1.3) cm,(1.6±1.2) cm,respectively. There was significant difference in data before and after operation. Preoperative,instantly postoperative,final follow-up,JOA score was 11.0±1.7,22.4±2.4,24.0±2.1,respectively;13 cases obtained excellent results,8 good,3 fair,2 poor. Loss of correction occurred in one case. No collapse of intervertebral space,nerve injury,breakage of fixation system were found. Conclusion: Surgical treatment with limited decompression,pedicle screw fixation and fusion is effective method for degenerative scoliosis with spinal stenosis,individualized surgery design should be made according to clinical symptoms,signs and imaging features.