退变性腰椎侧凸伴椎管狭窄症的手术治疗

目的 评价后路手术矫治退变性脊柱侧凸并椎管狭窄症的临床疗效,探讨退变性腰椎侧凸并椎管狭窄症的外科治疗策略.方法 1998年3月至2010年6月手术治疗退变性脊柱侧凸患者31例,行后路椎板减压、椎弓根钉棒矫形固定,椎间Cage植入,后外侧植骨融合,回顾性分析其手术方法与效果.观察手术前后Cobb角、冠状面平衡、矢状面平衡,采用VAS评分、ODI、VOA评分对手术前后疼痛症状、功能进行评定.结果 腰腿痛均消失,下肢麻木等症状减轻,随访6个月至4.4年,植骨融合良好,矫正度数与椎间隙高度无明显丢失.手术前、后侧凸Cobb角比较差异有统计学意义（P＜0.05）,术前冠状面Cobb角38°～56°,平均46.3°±9.2°,术后即刻21.7°±4.2°,矫正率51.5％,末次随访23.9°±5.8°,矫形率45.8％;腰椎矢状面曲度Cobb角-12°～42°,平均27.6°±5.1°,术后即刻-32°～-3°,平均-18.2°±4.9°,末次随访-42° ～-11°,平均-26.4°±8.3°.冠状面平衡C7PL与CSVL间距3.5 ～15.2 cm,平均（8.6±6.1）cm,术后即刻-3.9～1.8 cm,平均（-1.8±1.1）cm,末次随访-2.2～1.5 cm,平均（-1.4±0.9）cm,术后冠状面及矢状面平衡重建良好.VAS评分、ODI术前、术后比较差异有统计学意义,VOA评分本组患者术后疗效为优19例,良7例,可3例,差2例（翻修手术后症状改善最后评分良）,优良率为83.9％.结论 成人退变性腰椎侧凸治疗的主要目的是彻底减压,通过矫形使脊柱重新获得稳定,椎弓根钉棒固定及椎间融合是有效的治疗方法.

Surgical treatment of degenerative lumbar scoliosis complicated by spinal stenosis

Objective To evaluate the clinical efficacy of posterior surgical correction of degenerative scoliosis and spinal stenosis,and explore the surgical treatment strategies.Methods 31 cases of surgical treatment of degenerative scoliosis patients from March 1998 to June 2010,underwent posterior laminectomy decompression,pedicle screw orthopedic fixation and posterolateral fusion retrospective analysis of the surgical method and effect.Observed before and after surgery Cobb angle,the coronal plane balance,sagittal balance,VAS scores were assessed before and after surgery pain.Results Scoliosis average correction rate of 43％,low back pain disappeared,numbness and other symptoms relieved,followed up for 6 months to 4.4 years,interbody fusion,the degree of correction and intervertebral height without loss.All patients with preoperative severe waist weight,weight,standing,walking exacerbate,27 patients with lower limb radicular pain and/or hypoesthesia.Preoperative coronal Cobb angle of 38° to 56°,an average of 46.3°,immediate postoperative 21.7° ±4.2°,the correction rate of 51.5％ last followup of 23.9° ±5.8°,the correction rate of 45.8％.The difference of preoperative and postoperative Cobb angle was statistically significant （P ＜0.05）.Coronal the surface balance C7PL with CSVL spacing 3.5-15.2 cm,average 8.6 cm,immediately after-3.9 to 1.8 cm,average-1.8 cm,the last follow-up-2.2 to 1.5 cm,average-1.4 cm,postoperative coronal and sagittal face balanced reconstruction.31 cases last follow-up significantly alleviate back pain,intermittent claudication and leg pain disappeared or significantly reduced.VOA rated postoperative effects of this group of patients was excellent in 19 cases,good in 7 cases,3 cases and poor in 2 cases,good rate was 83.9％.Conclusions Adult degenerative lumbar scoliosis treatment is complete decompression by orthopedic spine to regain stability,pedicle screw and rod fixation and interbody fusion is an effective treatment method.The postoperative effects apart from responsibility lesions decompression,fusion rate,the reconstruction of the spine in the coronal and sagittal balance and restore the stability of the spine,interbody fusion segment selection is closely related to result effect.