退行性腰椎侧凸性椎管狭窄症的手术治疗

目的:探讨选择性腰椎后路减压、矫形固定、椎间结合后外侧植骨融合手术治疗退行性腰椎侧凸性椎管狭窄症的临床疗效。方法:21例退行性腰椎侧凸性椎管狭窄症患者,平均年龄为65岁,腰椎侧凸Cobbs角平均23.4°,术前根据患者症状、体征及影像学检查结果确定减压节段及选择融合节段,对引起临床症状的节段进行后路减压,针对术前即有不稳或减压术后可能出现不稳的节段行椎弓根钉棒系统矫形固定,椎间结合后外侧植骨融合治疗,比较患者手术前后Cobbs角,采用JOA29评分法对术前和末次随访时的神经功能和生活能力进行评分。结果:21例患者平均随访时间为25个月,所有患者疼痛明显缓解,生活质量提高。术前JOA评分平均15.2分,末次随访时平均26.3分(P<0.05),改善率为81.4%,侧凸术后平均矫正角度为13.6°,改善率平均41.9%。结论:选择性腰椎后路减压、矫形固定、椎间结合后外侧植骨融合手术是治疗退行性腰椎侧凸性椎管狭窄症的有效方法。

Operation Method for Degenerative Lumbar Scoliosis with Stenosis

Objective：To investigate therapeutic effects of selective posterior decompression,orthopedic fixation,and interbody fusion combined with posterolateral fusion for degenerative lumbar scoliosis with stenosis（DLSS）.Methods：Twenty-one cases of DLSS were reviewed retrospectively,the average age was 65 years old,and the mean angle of lumbar scoliosis Cobb＇s was 23.4°.The involved segments were determined by symptoms,clinical features,and radiographic documents.We carried out posterior decompression of the nerve roots on the segments according to the clinical symptoms,signs and imaging results.The orthopedic fixation of pedicle screw rod system and interbody fusion combined with posterolateral fusion were used on the segments with preoperative instability or probably iatrogenic postoperative unstable.The clinical outcomes were evaluated by Cobb＇s angle of preoperative and postoperative,the neurological functions and self-care abilities of the patients were evaluated by Japanese Orthopedic Association（JOA） score system from preoperatively until last follow-up period.Results：The average follow-up period was 25 months.The pain of all patients was relieved evidently and quality of live was improved.The average JOA score was 15.2 for preoperation and 26.3 for the last follow-up,the average improve rate was 81.4%（P〈0.05）.The average angle of postoperative scoliosis correction was 13.6°with the average improve rate of 41.9%.Conclusion：The technique of selective posterior decompression,orthopedic fixation,and interbody fusion combined with posterolateral fusion was effective for treating DLSS.