退变性腰椎侧凸的临床特征及个性化手术治疗

【目的】分析退变性腰椎侧凸（LDs）的临床特征，探讨个性化手术治疗方法。【方法】2003年2月至2008年9月。本院手术治疗LDs87例。其中男36例，女51例；平均年龄64．5（55～75）岁，平均病史4．2年（5～12年）。常规拍摄腰椎正侧位片及Bending片，备CT和MRI检查。所有患者都以双能量x线吸收测量仪（DExA）检测其骨密度。根据患者术前临床特点和影像学检查结果采用不同的手术治疗方法，包括单纯开窗神经根减压术；椎管有限减压加后路原位固定植骨融合术；半椎板或全椎板切除减压植骨矫形内固定术等。【结果】随访1～5年，平均2．6年。按VAS评分疗效评定标准，本组术后优68例（78％），良16例（18％），可3例（3％）。按0DI评分疗效评定标准，本组患者术后优57例（66％），良19例（22％），可10例（11％）。差1例（1％）。总体优良率为82％。围手术期无严重手术并发症发生。Cobb角由术前腰椎侧凸10°～42°，矫正到术后5°～20°，平均矫正14°，腰椎生理前凸由术前平均18°矫正到术后30°，内固定术后1、3个月及1、3、5年行X线腰椎正侧位复查，无内固定断裂，参照Kumar标准判定植骨融合情况，腰椎植骨融合平均时间12．5周，未见假关节形成。【结论】术前综合分析病情，明确疼痛的性质和部位，以解除疼痛为目的，选择个性化的减压、固定、融合、矫形治疗。采用腰椎后路减压、椎弓根固定植骨融合、矢状位重建术是安全有效的术式。

Clinical Characteristics and Individualized Surgery of Lumbar Degenerative Scoliosis

ObjectivelTo evaluate the clinical characteristics and individualized surgery of lumbar degenerative scoliosis. Methods]From Feb. 2003 to Sept. 2008, 87 cases with lumbar degenerative scoliosis were surgically treated in our hospital , including 36 male and 51 female patients with the mean age of 64.5 years （ranged from 55 to 75years）. The disease history was 5 months to 12 years（averaged 4.2 years）. All the patients were assessed by routine X-ray and Bending X-ray. CT and MRI were performed if necessary. The bone mineral of all patients was measured by dual-energy X-ray absorptiometry measurement （DEXA）. According to the imaging features and the clinical characteristic, different methods of surgical treatment were performed. Results] The follow-up was 1 year to 6 years （ averaged 2.6 years）. The neurological functions and self-care abilities of each patient were evaluated by VAS scoring system and the Oswestry disability index （ODD after operation. The overall satisfactory rate was 82%. No other severe complication such as perioperational death was noted. The Cobb＇s angle ranged from10 to 42 degrees and was corrected to 14 degrees at average after sur- gery. Conclusion]The condition of each patient should be completely understood before operation, especially the nature and location of pain . The purpose is to relieve the pain. Personalized treatments, such as decom- pression, fixation, fusion and correction should be applied. Fusion and reconstruction of the balance of spine on sagittal section with pedical screws and decompression of posterior lumbar is an effective and safe treatment.