后路椎弓根螺钉系统后路减压内固定治疗DLSS的效果

目的 探讨后路减压椎弓根螺钉内固定手术治疗退行性腰椎侧凸性椎管狭窄（DLSS）的临床疗效及安全性。方法 将2018年5月~2019年5月98例DLSS患者行后路减压椎弓根螺钉内固定手术治疗。比较患者手术前后VAS疼痛评分情况，术前、术后（6个月、术后12个月及24个月）Cobb角、腰椎前凸角、Oswestry功能障碍指数及并发症情况。结果 患者术后6个月疼痛评分为（3.12±1.84）分，低于术前的（5.61±2.32）分，差异具有统计学意义（P＜0.05）；治疗24个月后Cobb角显著较术前降低，而腰椎前凸角显著升高（P＜0.05）；患者手术前及术后6个月、12个月和24个月 Oswestry指数分别为（78.32±12.41）、（40.24±10.33）、（27.41±9.82）和（20.90±6.71），术后Oswestry指数较术前降低，差异有统计学意义（P＜0.05）。手术成功率为93.88%（92/98），术中发生神经根牵拉伤5例，6例患者发生脑脊液瘘，对症处理后均痊愈。结论 后路减压椎弓根螺钉内固定手术治疗退行性腰椎侧凸性椎管狭窄安全可靠，可缓解患者疼痛的同时纠正患者Cobb角及腰椎前凸角，提高患者生活质量。

The Effect of Posterior Decompression and Internal Fixation for DLSS in Posterior Pedicle Screw System

Abstract:Objective To evaluate the clinical efficacy and safety of posterior decompression and pedicle screw fixation for degenerative lumbar scoliosis (DLSS). Methods 98 patients with DLSS from May 2018 to May 2019 underwent posterior decompression and pedicle screw fixation. The VAS pain scores before and after surgery were compared. Cobb angle, lumbar lordosis angle, Oswestry dysfunction index and complications were observed before and after surgery (6 months, 12 months and 24 months after surgery).Results The pain score of patients at 6 months postoperatively was (3.12±1.84) points, which was lower than that of preoperative (5.61±2.32) points,the difference was statistically significant (P<0.05). The Cobb angle was significantly higher than that before surgery after 24 months of treatment. The lumbar lordosis angle was significantly increased (P<0.05). The Oswestry index was (78.32±12.41), (40.24±10.33), (27.41±9.82), and (20.90±6.71) before and 6 months, 12 months, and 24 months after surgery. The postoperative Oswestry index was lower than that before surgery,the difference was statistically significant (P<0.05). The success rate of operation was 93.88% (92/98).5 cases of nerve root traction injury occurred during operation. 6 patients developed cerebrospinal fluid spasm and recovered after symptomatic treatment.Conclusion Posterior decompression and pedicle screw fixation for the treatment of degenerative lumbar scoliosis is safe and reliable, can relieve the pain of patients and correct the Cobb angle and lumbar lordosis, and improve the quality of life of patients.