椎管狭窄伴退行性腰椎侧凸的减压及非融合动态稳定术疗效分析

目的：分析减压与非融合稳定系统运用在椎管狭窄伴退行性腰椎侧凸（DLS）患者的临床疗效。方法：对2014年1月至2017年6月接受减压及Dynesys系统非融合稳定手术治疗的48例椎管狭窄伴DLS患者进行回顾性分析，其中男17例，女31例，年龄54～78（64.3±5.7）岁。通过影像学观察术后腰椎前凸、侧凸角度及活动范围（ROM），采用视觉模拟评分（VAS）评价背部和腿部的疼痛情况，采用韩国版Oswestry残疾指数（ODI）评定临床功能。结果：48例患者施行了68个节段的减压与非融合稳定手术，均获得2年以上的随访，时间24～74（31.4±10.4）个月。手术时间100～220（183.1±31.8）min，术中出血量100～500（222.0±115.3）ml，住院天数4～9（6.5±1.9）d。术后腰椎侧凸角明显改善（P<0.05），腰椎前凸和活动范围未受影响。末次随访背部和腿部疼痛的VAS评分分别为3.5±2.4和4.2±4.3，ODI为（36.5±5.8）%，较术前明显改善。结论：对于椎管狭窄伴轻至中度脊柱侧凸（<30°）的老年患者，先后施行减压术与非融合稳定技术是一种安全有效的手术方法。

Decompression and nonfusion dynamic stable system for spinal stenosis with degenerative lumbar scoliosis

Objective:To analyze the clinical effects of decompression and non-fusion dynamic stable system in treating spinal stenosis with a mild to moderate degree of degenerative lumbar scoliosis(DLS).Methods:The clinical data of 48 patients with spinal stenosis and DLS underwent sugical treatment of decompression and non-fusion dynesys system were retrospectively analyzed. There were 17 males and 31 females,aged from 54 to 78 years old with an average of(64.3±5.7)years. The lumbar lordosis,lumbar scoliosis and range of motion were observed by image,the states of back pain and leg pain were evaluated by visual analogue scale(VAS),the clinical functions were assessed by Oswestry Disability Index(ODI).Results:A total of 68 segments in 48 patients were treated by decompression and nonfusion stable system. All patients were followed up more than 2 years,follow-up time in range was 24 to 74 months with an average of (31.4±10.4) months. Operation time was 100 to 220 (183.1±31.8) min,intraoperative bleeding was 100 to 500 (222.0±115.3) ml,hospital day was 4 to 9 (6.5±1.9) d. Postoperative lumbar scoliosis was obviously improved (P<0.05),lumbar lordosis and range of motion was not effected. At final follow-up,VAS of back pain and leg pain were 3.5±2.4 and 4.2±4.3,ODI was(36.5±5.8)%,had obviously improved than preoperation.Conclusion:Using nonfusion stable system after decompressive surgery resulted in a safe and effective procedure for elderly patients with lumbar stenosis of a mild to moderate scoliosis (scoliosis angle< 30°).