退变性腰椎侧凸的手术治疗及疗效

目的探讨退变性腰椎侧凸的后路手术方法和手术疗效。方法回顾性分析2007~2012年本院手术治疗并获得随访的32例退变性腰椎侧凸患者的手术方法及疗效。患者均接受腰椎后路减压椎间融合器植骨融合内固定术,术后随访6个月~6年。采用下腰痛Oswestry功能障碍指数(Oswestry disability index,ODI)对患者手术前后的临床症状进行评分和疗效评价;通过手术前后冠状位和矢状位Cobb角度的比较,了解患者手术治疗的侧凸矫正率和腰椎前凸的恢复情况。结果患者ODI术前(52.30±13.65)%、术后(9.62±6.41)%,术前术后比较差异有统计学意义(P0.05),术后疼痛改善率为81.6%。32例患者中,24例疗效为优,6例疗效为良,2例疗效为可,术后疗效评价的优良率为93.8%。患者冠状位Cobb角术前21.99°±8.97°、术后6.84°±5.32°,术前术后比较差异有统计学意义(P0.05),侧凸矫正率为69.0%。患者腰椎前凸Cobb角术前13.80°±15.99°、术后24.95°±12.86°,术前术后比较差异有统计学意义(P0.05)。结论退变性腰椎侧凸采用腰椎后路减压椎间融合器植骨融合椎弓根螺钉内固定术治疗效果较理想,术后疗效满意。手术的关键是彻底减压、正确选择融合节段、重建退变节段椎间高度、矫正前凸减少和后凸畸形、纠正椎体侧方移位和侧凸畸形以稳定椎体。

Surgical methods and curative effect evaluation of degenerative lumbar scoliosis

Objective To investigate surgical methods and curative effect of degenerative scoliosis via posterior approach. Methods A retrospective analysis of the surgical methods and curative effect was performed to 32 patients with degenerative lumbar scoliosis,who were treated with posterior approach neural decompression and interbody fusion combined with pedicle screw fixation and followed-up 6 months to 6 years from 2007 to 2012. By comparing with pre-and post-operatively coronal and sagittal Cobb's angle and Oswestry disability index(ODI)of low back pain, to understand the surgical efficacy, the scoliosis correction rate and the angle increase in lordosis. Results The operative efficacy is satisfying via surgical treatment.ODI was (52.30 ± 13.65)% pre-operatively and (9.62 ± 6.41)% post-operatively. The difference was statistically significant bewteen pre-operation and post-operation(P <0.05). Pain improvement rate was about 81.6% post-operatively.Among 32 patients, 24 was excellent, 6 was better, 2 was good and 0 was poor in the surgical efficacy.The acceptance rate of surgical efficacy was 93.8%. Coronal Cobb's angle was 21.99° ±8.97° pre-operatively and 6.84°±5.32° post-operatively. The difference was statistically significant bewteen pre-operation and post-operation(P <0.05).The scoliosis correction rate was 69%. Lumbar lordosis angle was 13.80°±15.99° pre-operatively and 24.95°±12.86° post-operatively. The difference was statistically significant bewteen pre-operation and post-operation(P <0.05). Conclusion Posterior decompression combined with posterior lumbar interbody fusion and pedicle screw fixation is an ideal treatment of degenerative scoliosis. Patients are satisfied with the surgical curative effect. The key points of the surgical technique is complete decompression, correct choice of fusion segment, reconstruction degeneration intervertebral height and correction lordosis reduction and kyphosis, correcting vertebral lateral shift and scoliosis deformity, stabilize the vertebral body.