摘要
[目的]探讨Smith-Peterson截骨术治疗退行性腰椎侧凸畸形的可行性及优点。[方法]回顾分析自2004年5月～2007年10月手术治疗退行性腰椎侧凸畸形病例25例。其中,男11例,女14例;年龄:56～77岁,平均67岁。25例患者均行三个阶段以上的腰椎Smith-Peterson截骨+椎弓根螺钉内固定术重建脊柱冠状面和矢状面平衡。[结果]手术时间150～320min,平均200min,术中出血量600～2000ml,平均1000ml。术后脑脊液漏2例,均通过拔管压迫缓解,术后双下肢酸痛麻木加重2例,1例3周后完全缓解,1例12周后完全缓解。随访24～60个月,平均36个月。采用下腰痛JOA29分标准进行评定,优良率88.2%,差0%。冠状位Cobb’s角由术前平均23°(15°～40°)改善至术后平均12°(8°～20°);矢状位Cobb’s角由术前平均0°(-15°～15°)改善至术后平均33°(25°～40°)。[结论]通过Smith-Peterson截骨术可有效地对腰椎管狭窄减压,同时有助于矫正退行性腰椎侧凸的矢状位畸形,该术式具有对患者神经干扰相对较小的优点。
[Objective]To investigate the feasibility and merits of the Smith-Peterson osteotomy for the treatment of degenerative lumbar scoliosis. [Methods]Twenty-five patients（11 males,14 females）with degenerative lumbar scoliosis malformations underwent operations from May 2004 to October 2007.The mean average age were 67 years （range,56-77 years）.All the patients underwent more than three segments Smith-Peterson osteotomy and lumbar pedicle screw fixation to have the reconstruction of spinal coronal and sagittal plane balance.[Results]The mean duration of surgery were 200 mins（range,150-320 mins）,and the average intraoperative blood loss were 1000 ml （range,600-2 000 ml）.There were two cases of postoperative cerebrospinal fluid leakage,which were alleviated by pulling drainage tube and oppressing the wound.Postoperative pain and numbness in both lower extremities were aggravated in 2 cases,one of which was recovered completely 3 weeks later,and another 12 weeks later.The mean clinical follow-up were 36 months（range,24-60 months）.JOA 29 score was recorded to evaluate the relief of the symptoms.The good-to-excellent rate was 88.2% and the poor rate was 0%.The coronal Cobb＇s angle was improved from the preoperative average of 23° （range,15°- 40°） to the postoperative average of 12° （range,8°- 20°）.The sagittal Cobb＇s angle was improved from the preoperative average of 0 °（range,-15°- 15°） to the postoperative average of 33°（range,25°- 40°）.[Conclusion]Smith-Peterson osteotomy is an effective method for the decompression of lumbar spinal stenosis,and is helpful to correct the sagittal deformity of the degenerative lumbar scoliosis.It also has relatively small interference to nerve in the operation.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第9期721-724,共4页
Orthopedic Journal of China
关键词
退行性腰椎侧凸
截骨
内固定
重建
degenerative lumbar scoliosis
osteotomy
internal fixation
reconstruction
