腰椎退变性侧弯植入物置入的内固定治疗

背景：腰椎退行性疾病为骨科常见病之一，是否行手术治疗，以及手术治疗的方法一直以来都存在着很大争议。目的：分析腰椎退变性侧弯植入物置入内固定治疗的疗效，对患者的症状、腰椎退变节段以及影像学等相关病情进展性的评估，系统回顾相关腰椎退变性疾病的文献。方法：选取2010年3月至2012年8月在解放军第306医院骨科治疗的腰椎退变性侧弯患者共61例，男30例，女31例；年龄范围在42—78岁，平均年龄59．02岁。其中行腰椎后路减压植入物置入内同定植骨融合患者32例：后路动力系统腰椎置入内固定患者29例。术后随访时间为6—29个月，平均随访时间为16个月。采川目测类比评分、ODI评分、JOA评分系统进行术前、术后以及随访评估。并检索腰椎退变性侧弯植入物置入内同定治疗的孝H关研究文献，对文献的实验方法和实验结果进行深入分析。

Internal fixation for the treatment of lumbar degenerative scoliosis

BACKGROUND： Lumbar degenerative disease is one of the common orthopedic diseases, and there is controversy on the methods of operation and whether the operation should be preformed. OBJECTIVE： To analyze the effect of internal fixation on the treatment of lumbar degenerative scoliosis, to assess the development of the patient＇s symptoms, lumbar renegade segment and imaging, and to systematic review the literatures related degenerative diseases. METHODS： A total of 61 patients （30 cases in male and 31 cases in female, the age ranged 42 78, average in 59.02） with lumbar degenerative scoliosis were selected from Department of Orthopedics, the 306th Hospital of PLA during March 2010 to August 2012. Among the 61 patients, 32 patients treated with lumbar posterior decompression and internal fixation and fusion; 29 patients treated with lumbar posterior dynamic system. The postoperative follow-up time was 6 29 months, and average in 16 months. Visual Analogue Scale, Oswestry disability Index and Japanese Orthopaedic Association Scores were used for the preoperative, postoperative and follow-up assessment. The literatures on the treatment of lumbar degenerative scoliosis by internal fixation were screened out, and the experimental methods and the results in the literatures were analyzed in-depth. RESULTS AND CONCLUSION： The gender and age of the patients were consistent with the incidence of lumbar degenerative scoliosis and age reported in the literatures. Visual Analogue Scale, Oswestry disability Index and Japanese Orthopaedic Association Scores showed that that there was no statistically significant difference at 1 and 3 monthspostoperation （P 〉 0.05）; at 1 year postoperation, there was statistically significant difference of Visual Analogue Scale Oswestry disability Index and Japanese Orthopaedic Association Scores （P 〈 0.05）. Lumbar posterior decompression and internal fixation has the advantages of wide adaptation range, longer clinical application time and higher familiarity degree, it has the disadvantages of poor compliance, heavier degeneration degree of adjacent segments and higher incidence of complications. Dynamic fixation system can not only ensure the stability of internal fixation, but also better play the internal fixation characteristics, and the long-term follow-up showed better compliance for the dynamic fixation therefore had the therapeutic effect, and retained the activities of the patient＇s lumbar.