摘要
[目的]探讨一种对手术治疗具有指导意义的成人退变性腰椎侧凸的临床分型。[方法]回顾性分析1994～2004年10年间手术治疗的成人退变性腰椎侧凸患者168例，根据站立位脊柱全长X线平片上椎体的旋转、前后或侧方移位程度以及冠状面和矢状面躯干的平衡分为三型。Ⅰ型：很小或没有旋转；Ⅱ型：明显旋转和移位；Ⅲ型：重度旋转和移位，伴有冠状面和／或矢状面躯干的不平衡（C2铅垂线偏移〉4cm）。再结合患者的临床症状和体征（腰痛及神经根性疼痛）分为三个亚型。A型：腰痛，不伴有神经根性痛；B型：来自腰骶部代偿侧凸的神经根性痛，伴或不伴腰痛；C型：来自主侧凸的神经根性痛，伴或不伴腰痛。[结果]ⅠA型3例，IB型28例，IC型6例；ⅡA型21例，ⅡB型45例，ⅡC型39例；ⅢA型12例，ⅢB型6例，ⅢC型8例。其中IA型以后外侧椎间融合或经椎间孔椎间融合为主；IB、IC型的手术方法以单纯椎管减压为主；ⅡA、ⅡB、ⅡC型以后路椎管减压加后外侧融合术为主；ⅢA、ⅢB、ⅢC以前路椎间融合加后路器械矫形、椎管减压及后外侧融合术为主。[结论]此分型简便实用，尤其对手术方法的选择具有指导意义。
[ Objective] To explore a clinical classification system for the guideline of adult de novo degenerative lumbar scoliosis （ADDLS） . [ Methods] Totally 168 cases were diagnosed as ADDLS and underwent surgery during 1994 and 2004. ADDLS were classified into three types based on vertebral rotation, olisthesis and coronal and/or sagittal balance on full - length standing spine plain anteroposterior radiographs： type Ⅰ minimal or no rotation; type Ⅱ, rotatory olisthesis; type Ⅲ, rotatory olistbesis and coronal or sagittal imbalance （ C7 PL 〉 4 cm） . Three subtypes were further classified based on the patients clinical symptoms and signs （back pain and radiclular pain） ： A, back pain without radicular symptoms; B, radicular symptoms （ from the lumbosacral hemicurve proved with SNRB） ±back pain ; C, radicular symptoms （ from the major curve proved with SNRB） ±back pain. [ Results] There were [ A in 3 cases, ｜ B 28 cases, Ⅰ C 6 cases, ⅡA 21 cases, Ⅱ B 45 cases, ⅡC 39 cases, ⅢA 12 cases, ⅢB 6 cases, ⅢC 8 cases respectively. Type I A were basically treated with PLIF OR TLIF ; Type I B and type I C were treated with decompression; type Ⅱ A, ⅡB and Ⅱ C were treated with decompression and PLF ; type Ⅲ A, Ⅲ B and Ⅲ C were treated with combined ALIF and PLF. [ Conclusion ] This classification is simple and practical, especially providing the guideline for surgical options of ADDLS.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第1期22-25,共4页
Orthopedic Journal of China
关键词
成人
退变性腰椎侧凸
分型
手术
adults
de novo degenerative lumbar scoliosis （ADDLS）
classification
surgery
