短节段固定融合术治疗退变性腰椎侧凸合并腰椎管狭窄疗效观察

目的探讨短节段固定融合术治疗退变性腰椎侧凸(DLS)合并腰椎管狭窄的手术策略、影像学及临床疗效。方法选择性减压、短节段固定融合术治疗68例DLS合并腰椎管狭窄患者,比较患者术前及末次随访时的Cobb角、腰椎前凸角、冠状面躯干偏移及矢状面躯干偏移。以Oswestry功能障碍指数(ODI)评估患者功能改善情况。结果患者均获得随访,时间36~60个月。Cobb角术前12°~28°(15.9°±4.6°),末次随访3.6°~9.8°(5.2°±3.1°);腰椎前凸角术前1.2°~3.3°(1.9°±2.9°),末次随访-28.1°~4.6°(-23.6°±3.7°);冠状面躯干偏移术前8.2~13.7(10.8±5.2)mm,末次随访2.8~5.6(4.3±1.8)mm;矢状面躯干偏移术前10.2~15.6(12.6±3.7)mm,末次随访3.1~6(4.6±2.2)mm;ODI评分术前25.2~29.8(27.6±2.1)分,末次随访2.1~4.2(3.6±1.3)分。以上各项指标末次随访与术前比较差异均有统计学意义(P0.05)。术后早期并发症发生率为7.3%。末次随访时未发现钉棒松动或断裂等情况。结论对于冠状面Cobb角30°且躯干失平衡较小的DLS合并腰椎管狭窄患者,行选择性减压、短节段固定融合可获得良好的中期临床疗效。

Clinical effect analysis of short-segment fixation and fusion for degenerative lumbar scoliosis ;combined with lumbar stenosis

Objective To investigate the surgical strategies and clinical results of short-segment fixation and fusion for degenerative lumbar scoliosis ( DLS) combined with lumbar stenosis .Methods Sixty-eight cases of DLS with lumbar spinal canal stenosis underwent selective decompression and short segmental fixation and interbody fusion .The Cobb angle, lumbar lordosis, coronal plane trunk shift , and sagittal plane trunk shift in the preoperative and final follow-up were measured .Function were assessed by Oswestry disability index ( ODI) .Results All the patients were followed up for 36~60 months.The Cobb angle was 12°~28°(15.9°±4.6°) preoperatively and was 3.6°~9.8°(5.2°± 3.1°)at final follow-up;lumbar lordosis was 1.2°~3.3°(1.9°±2.9°) preoperatively and was -28.1°~4.6° (-23.6°±3.7°) postoperatively;coronal plane trunk shift was 8.2~13.7 (10.8 ±5.2 ) mm preoperatively and was 2.8~5.6(4.3 ±1.8)mm at final follow-up;sagittal plane trunk shift was 10.2~15.6(12.6 ±3.7)mm preoper-atively and was 3.1~6(4.6 ±2.2)mm at final follow-up;the ODI was 25.2~29.8(27.6 ±2.1)points preoperative-ly and was 2.1~4.2(3.6 ±1.3)points at final follow-up.There were statistically significant differences in the above indexes between the final follow-up and the preoperative comparison ( P<0.05 ) .The early complication incidence rate was 7.3%.At the final follow-up, there was no instrument-related failure.Conclusions The selective decom-pression and short-segment fixation and fusion is an safe and effective technique for DLS combined with spinal stenosis patients with small Cobb angle (<30°) and minor spinal imbalance .