退变性腰椎侧凸的外科治疗

目的探讨退变性腰椎侧凸手术治疗的临床疗效。方法自2003年10月至2007年8月,手术治疗退变性腰椎侧凸45例,其中4例行单纯椎管减压术,25例行减压＋后路内固定融合术,16例行减压＋后路内固定融合术＋椎间隙植入C age。术后常规抗炎,营养神经,对症处理,佩戴胸骶或腰骶支具3个月。结果本组均获得随访,时间6~30个月,平均18个月,93.3%的患者术后症状体征得到了明显的改善,生活质量提高。X线发现Cobb角术后平均9.3°（0~°20°）,改善率为61.4%,并且无断钉及螺钉松动。10例出现并发症,5例硬膜撕裂,发生脑脊液漏,1例肺部感染,1例脑梗死,2例假关节形成,1例腰痛症状加重,经保守治疗症状缓解。结论彻底减压是术后获得良好效果的保证,在充分减压解决患者疼痛的前提下,最大限度重建脊柱在冠状面和矢状面的平衡,恢复脊柱的稳定性是治疗退变性脊柱侧弯较理想的手术方法。

The Surgical Treatment of Degenerative Lumbar Scoliosis

Objective To study the clinical effects of surgical treatment for degenerative lumbar scoliosis.Methods 45 cases of surgical treatment for degenerative lumbar scoliosis between Oct 2003 and Aug 2007 were studied.Among them,4 cases only received spinal canal decompression;25 cases were treated with spinal canal decompression and posterior internal fixation and interbody fusion;Besides these treatments,the other 16 cases also received cage fusion between intervertebral space.All cases received postoperative routine anti-inflammatory,nerve nutrition and expectant treatment,and adorn orthosis between thoracic and sacral vertebrae or between lumbar and sacral vertebrae for 3 months.Results All these cases were followed up,the follow-up duration ranged from 6 to 30 months（average 18 months）.93.3% of these cases symptom and signs were obviously improved,also improved was their quality of life.X-ray found the average cobb angle after surgical treatment was 9.3°（0°～20°）.The improvement rate was61.4%;Besides,there was no nail broken and screw loosening.10 cases had complications.Among them,5 cases had dural tear and cerebrospinal fluid leakage,1 case had pulmonary infection,1 case had cerebral infarction,2 cases had pseudoarthrosis formation,1 case had aggravated low back pain.Conclusion Thorough decompression was the basis of good effects after surgery.Based on the relief of pain by decompression,rebuilding the balance of vertebral column in the coronal plane and sagittal plan maximatily,restoring the spinal stability is an ideal surgical treatment for degenerative lumbar scoliosis.