退变性腰椎侧凸对预后影响的相关因素分析

目的 分析影响退变性腰椎侧凸术后临床效果的相关因素.方法 回顾性分析自2001年2月至2009年6月,共计51例在我院行腰椎后路侧弯矫形选择性椎板减压植骨融合内固定术的退变性腰椎侧凸患者,在T1加权像上评价椎间孔的狭窄程度,根据椎间孔的狭窄程度将所有患者分为3组,应用Oswestry功能障碍指数评价临床结果,在研究过程中我们注意到有一部分患者有严重的坐骨神经痛症状以至于腰椎在矢状面上只能做很小范围的活动,即使使用激素、度冷丁也只能在短时间内轻微缓解,由于这种症状在腰椎管狭窄症患者中很少见到,在这篇研究中我们把这种症状作为一个观测指标.结果 3组患者的年龄、术前ODI指数、末次随访时ODI指数的改善率经过方差分析差异有统计学意义（P＜0.05）;3组患者的重度坐骨神经痛、性别经过Person χ2检验在各组间的分布均有统计学差异（P＜0.05）;病程在3组间的分布均有统计学差异（P＜0.05）,Cobb角在3组间有统计学差异（P＜0.05）.多因素分析结果 显示患者的病程、椎间孔狭窄的程度、术前的Cobb角同时影响术后ODI指数改善率.结论腰椎间孔狭窄程度较轻组,病程较短,Cobb角较小,术后效果较好.反之随着腰椎间孔狭窄程度加重,病程较长,Cobb角较大,患者术前ODI指数逐渐增加,重度坐骨神经痛出现的概率较大,术后效果较差.患者病程及腰椎间孔狭窄程度是影响退变性腰椎侧凸手术效果的重要因素.

The analysis on relative factors of the impact of degenerative lumbar scoliosis on prognosis

Objective To analyze the impact factors of the postoperative clinical outcomes of degenerative lumbar scoliosis. Methods 51 patients with degenerative lumbar scoliosis underwent posterior scoliosis correction, selective decompression of the vertebral plate and interbody fusion with internal fixation in our hospital from February 2001 to June 2009, and their data were retrospectively analyzed. Based on the T1-weighted images, the degree of lumbar foraminal stenosis was evaluated. All patients had been divided into 3 groups with the grading system for lumbar foraminal stenosis. The clinical outcomes were measured using the Oswestry Disability Index （ODI）. With severe sciatica, some patients who had small spinal mobility in the sagittal plane drew our attention in this study. Even the hormone or dolantin could only provide short-term slight relief for them. Such symptom rarely occurred in patients with lumbar spinal stenosis, so we took the symptom as an observation index in this study. Results There were statistically significant differences among the 3 groups by comparing the age, preoperative ODI score and improvement rate of ODI in the latest follow-up through the analysis of variance （P〈0.05）. There were statistically significant differences among the 3 groups by comparing the symptom of severe sciatica and gender through Pearson 2 test （P〈0.05）. There were statistically significant differences in the duration of disease （P〈0.05） and Cobb angle （P〈0.05） among the 3 groups. Multiple linear regression analysis showed that the duration of disease, the degree of lumbar foraminal stenosis and the preoperative Cobb angle were the predominant correlative factors affecting the postoperative improvement rate of ODI. Conclusions With mild degree of lumbar foraminal stenosis, the patients who had a shorter duration of disease and a smaller Cobb angle have good surgical outcomes. However, with the aggravation of lumbar foraminal stenosis, the patients who have a longer duration of disease and a larger Cobb angle, and their preoperative ODI scores increase gradually and severe sciatica occurs more frequently have bad surgical outcomes. The duration and degree of lumbar foraminal stenosis are the important factors that affect the surgical outcomes of degenerative lumbar scoliosis.