后路矫形、植骨融合治疗退行性腰椎侧弯的临床探讨

目的 探讨分析后路矫形、植骨融合治疗退行性腰椎侧弯的临床效果和手术策略.方法 对2003年5月至2009年5月行后路手术治疗的27例退行性腰椎侧弯患者的临床资料进行回顾性分析.27例患者均采用椎管减压、椎弓根内固定系统矫形,其中18例采用后外侧植骨融合,9例因存在腰椎滑脱采用360°融合.结果 27例患者随访12个月,主观满意度为88.9%(24/27),Oswestry评分为(21.54±1.95)%;22例患者随访24个月,主观满意度为86.4%(19/22),Oswestry评分为(24.26±2.32)%.术后12、24个月Oswestry评分较术前的(57.83±2.71)%均明显降低,差异有统计学意义(P＜0.05).侧弯冠状位Cobb角矫正率为47.2%;腰椎前凸角度从术前的23.6°±8.3°改善至术后的43.8°±9.1°.围手术期1例发生切口感染,2例出现心血管系统疾病,1例术后3个月出现螺钉松动.结论 在充分减压、改善腰椎前凸角度情况下,采用后路矫形、植骨融合治疗退行性腰椎侧弯,可以获得满意的治疗效果.

Study on the results in patients treated posterior correction and fusion for degenerative lumbar scoliosis

Objective To investigate the surgical strategy for degenerative lumbar scoliosis (DIS)and evaluate the clinical results of the posterior correction and fusion technique. Methods From May 2003 to May 2009,27 patients with DIS were treated posterior operation. All the patients were performed posterior laminectomy,spinal fusion and correction with pedicle screws system. Among the patients, 18 cases with posterolateral bone grafting,9 cases complicated spondylolishesis with PLIF intervertebral combined with posterolateral fusion. Results All the cases were followed up for a minimum of 12 months and 88.9% (24/27) of them had excellent or good outcome, Oswestry score was(21.54 ± 1.95 )%;22 cases were followed up for 24 months and showed a rate for excellent or good results of 86.4%( 19/22),and Oswestry score was (24.26 ± 2.32)%. Oswestry scores of the postoperative 12,24 months were lower than that before operation (57.83 ± 2.71 )%. There was statistical difference in the cases preoperation and postoperation. Correction of scoliosis of the coronal plane was 47.2%. Preoperative lumbar lordosis was augmented from 23.6°± 8.3° to 43.8°± 9.1°. One case complicated with wound infection during perioperation period, and 2 eases with heart diseases. The screw of 1 case was loosening at 3 months postoperation. Conclusion Decompressing thoroughly and improving lumbar lordosis, the operation of posterior correction and bone graft fusion shows good results for degenerative lumbar scoliosis.