经后路手术治疗退变性脊柱侧弯的效果

目的探讨退变性脊柱侧弯经后路手术治疗的术式选择及其临床效果。方法回顾总结2010年4月-2012年12月经后路手术治疗的38例退变性脊柱侧弯病人的手术方式、术后效果、并发症及随访情况。结果全部病例无术中死亡。术后随访6～32个月，平均14．3个月，无内固定松动及断钉等情况，所有融合节段均已骨性融合。侧弯平均矫正率68．5％，腰痛改善率94．7％。病人均自诉生活质量较术前显著改善；无病人出现术后假关节形成，发生脑脊液漏1例，切口溃疡1例，肺部感染2例。结论经后路手术治疗退变性脊柱侧弯安全有效。术式选择应根据病人的临床症状、辅助检查结果及身体状况决定。充分减压是有效缓解病人疼痛的前提，在此基础上行长节段固定、短节段融合能够最大限度恢复脊柱在冠状位及矢状位上的平衡，重建脊柱的稳定性并长期维持。

THE EFFECT OF POSTERIOR APPROACH ON DEGENERATIVE SCOLIOSIS

Objective To discuss the types of posterior approach and its efficacy for degenerative scoliosis. Methods From April 2010 to December 2012. 38 patients with degenerative scoliosis underwent posterior approach surgery. their operations. postoperative effect. complications and follow-up were reviewed retrospectively. Results No intraoperative death was noted. Postoperative follow-up was carried out for 6-32 months. with an average of 14.3 months. no internal fixation loosen or broken nail was found. bony fusion was seen in all the fusion segments. The average correction rate of scoliosis was 68.5%. low back pain improved by 94.7%; the quality of life of patients was much better than before surgery. no pseudarthrosis formation was noted. Cerebrospinal leakage was found in one patient. incision ulcer in one. and lung infection in two. Conclusion Posterior approach is safe and effective for the treatment of degenerative scoliosis. the type of surgery should be decided according to clinical symptoms and results of auxiliary examinations as well as patient＇s physical status. Full decompression is the premise for effective pain remission. internal fixation in long segment and fusion in short segment can restore the spine equilibrium in the coronal and sagittal plane and rebuild vertebral stability and long-term maintenance.