退行性脊柱侧凸的手术治疗及相关文献回顾

目的　在回顾手术治疗退行性脊柱侧凸进展的基础上 ,探讨椎弓根螺钉系统在退行性脊柱侧凸矫治的策略 ,并评价其疗效。方法　 1999年 7月～ 2 0 0 2年 7月 ,本院骨科连续治疗 32例退行性脊柱侧凸患者 ,其中 7例先行一期前路脊柱松解 ,二期后路多节段椎弓根螺钉矫形 ,后外侧植骨融合 ;16例行后路椎管减压、PLIF椎体间支撑融合、椎弓根螺钉矫形内固定、后外侧植骨融合术 ;9例行后路椎管减压、椎板截骨短缩、椎弓根螺钉矫形内固定、后外侧植骨融合术。结果　本组围手术期没有出现切口感染 ,2例术后出现肺部感染症状 ,4例出现症状对侧的下肢痛 ,经过对症处理后好转。本组全部病例随访 18个月～ 3年 ,平均 2 .4年。全部病例无断钉、断棒 ,无交界性后凸。术前、术后及 18个月随访时进行Oswestry评分 ,统计结果表明术后和 18个月随访时ODS评分与术前有显著性差异 (P >0 .0 5 )。结论　在充分减压的前提下 ,椎弓根螺钉三维矫正技术对退行性脊柱侧凸可达到满意的纠正 ,重建脊柱稳定性 ,适当的前路松解和椎体间支撑性植骨有利于矢状面畸形的改善 ,减少神经并发症的发生

Surgical treatment for degenerative scoliosis and related literature review

Objective To investigate the surgical strategy for degenerative scoliosis and evaluate the clinical effect of pedicle screws in correction based on related clinical review.Methods From July 1999 to July 2002, 32 cases with degenerative scoliosis were treated in our hospital. In these cases, 7 cases had anterior spinal release on the first stage, and posterior correction with pedicle screws system and posterolateral bone graft on the second stage; 16 cases had posterior decompression, PLIF intervertebral sustaining fusion and pedicle screws correcting fixation combined with posterolateral bone graft fusion on one stage; 9 cases had posterior decompression, laminectomy for short and pedicle screws correcting fixation combined with posterolateral bone graft fusion on one stage.Results After the operation, no wound infection occurred, pneumonic infection occurred in 2 cases, and opposite lower limb pain occurred in 4 cases. These complications were cured after appropriate treatment. A follow-up was taken in these cases ranged from 18 months to 3 years (mean 2.4 years). No instrumentation broken, and all these cases were evaluated on ODS preoperatively, postoperatively and during the 18-month-long follow-up. Statistic analysis showed that preoperative ODS had remarkable difference with those postoperatively and during the 18-month-long follow-up (P>0.05).Conclusion Pedicle screws correcting fixation can get satisfactory effects on degenerative scoliosis after enough decompression. It can reconstruct spinal stability. Appropriate anterior release and intervertebral sustaining bone graft can improve sagittal abnormality and minimize neurological complications.