退变性脊柱侧弯的外科治疗探讨

目的 探讨后路椎间融合器结合经椎弓根系统治疗退变性脊柱侧弯的技术要点、手术适应证，评价其临床效果。方法 回顾性分析1997年9月至2002年2月手术治疗的45例退变性脊柱侧弯患者。其中21例患者使用椎弓根内固定系统结合椎间融合器行后路同定融合并同时进行侧弯矫正；16例患者行椎管减压结合单纯椎弓根内固定融合术；8例患者行单纯减压手术。随访期间观察侧弯的矫正效果、椎间融合情况及并发症。结果 全部患者手术顺利，术后恢复良好。随访时间平均13个月(6—49个月)。88％的患者疼痛明显缓解，下肢神经源性间歇性跛行缓解，自诉生活质量明显提高。使用内固定及融合器患者随访期内矫正度数、椎间隙高度无丢失。未行内固定者术后残留下腰痛症状者的比例明显高于使用内同定患者。结论 退变性脊柱侧弯病变较复杂，手术方案应根据侧弯程度、椎管狭窄程度、间盘及小关节退变情况等多种因素决定。采用后路椎间融合器结合经椎弓根系统是治疗严重退变性脊柱侧弯的一种安全有效的方法。

Surgical treatment of degenerative scoliosis

OBJECTIVE: To investigate the techniques and indications of treatment of degenerative scoliosis. METHODS: The clinical data of 45 degenerative scoliosis patients, 18 males and 27 females, aged 41 - 77, all suffering from severe low back pain, were analyzed. Twenty of them underwent posterior lumbar interbody fusion with pedicle screws combined with correction of scoliosis. Sixteen patients underwent depression of vertebral canal and pure internal fixation and fusion of pedicle. Eight patients underwent pure depression, such as laminectomy or incision of intervertebral foramen. The corrective effects of scoliosis, condition of intervertebral fusion, and complications were observed. RESULTS: All operations were performed successfully and all the patients made a remarkable recovery. During the 13 months' follow-up, 88% of the patients showed remarkable relief from pain and claudication and improved life quality. No loss in correction angle and height of disc space was found among the patients who had undergone internal fixation and interbody fusion. The residual symptom of low back pain was more manifest in the patients who had not undergone internal fixation than in those who had. CONCLUSION: Posterior lumbar interbody fusion with pedicle screws is safe and effective in the treatment of severe degenerative scoliosis.