摘要
目的探讨责任节段减压固定融合术治疗腰椎管狭窄症合并退行性腰椎侧凸的临床疗效。方法回顾性分析2008年7月至2013年10月收治30例合并退行性腰椎侧凸的腰椎管狭窄症患者的病历资料，男11例，女19例；年龄47-73岁，平均（60．3±12．7）岁。术前正、侧位脊柱全长x线片示腰椎侧凸Cobb角平均为24．3°±8．8°，腰椎前凸角平均为30．5°±15．5°。结合体格检查的神经定位和影像学表现确定责任节段。手术方式为责任节段减压固定融合术。采用Oswestry功能障碍指数（oswestry disability index，ODI）和腰背部疼痛VAS（visual analogue scale，VAS）评分评估患者疼痛和功能情况。影像学评价采用冠状面参数，包括腰椎侧凸Cobb角和C7椎体中心至骶骨中垂线距离（C7 plumb line-center sacral vertical line，C7PL-CSVL）；矢状面参数，包括腰椎前凸角（lumbar lordosis，LL）、骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）、矢状面平衡（sagittal vertical axis，SVA）。比较术前和术后随访的冠状面参数、矢状面参数、ODI和VAS评分等改善情况。结果30例患者均获得随访，随访时间21-73个月，平均（46．0±10．9）个月。术前与末次随访腰痛和下肢痛VAS评分、ODI的差异有统计学意义。术前与末次随访时腰椎侧凸Cobb角和C7PL-CSVL的差异有统计学意义。术前与末次随访时LL、SS、PT、SVA的差异均有统计学意义。末次随访时较术前腰痛VAS评分、ODI的改善与手术前后矢状面参数的LL、PT改变具有明显相关性，而与手术前后冠状面参数的改变无关。术后并发症发生率为33．3％。结论合并退行性腰椎侧凸的腰椎管狭窄症患者，可通过责任节段减压固定融合明显改善患者的生活质量和腰背部疼痛，其临床疗效确切，围手术期并发症可控。
Objective To investigate the clinical results of selective decompression and short-segment fusion with fixation for symptomatic degenerative lumbar stenosis combined with lumbar seoliosis. Methods All of 30 patients from Jul. 2008 to Oct.2013 were recruited for this retrospective study. There were 11 males and 19 females, whose mean age was 60.3±12.7 years. The preoperative X-ray of the total spine showed the mean Cobb＇s angle was 24.30°±8.8°. And the mean lumbar lordosis angle was 30.5°±15.5°. Pain and function were assessed by Visual Analogue Scale （VAS） and Oswestry dsability index （ODI）. The responsible segments were determined from physical examination and radiological findings. Selective decompression and short-segment fixation and fusion were performed. The radiographic parameters, ODI, VAS of pre-operation and post-operation were recorded and compared. Results All the patients were followed up for 21-73 months with mean 46.0± 10.9 months. The complication incidence was 33.3%. The ODI and VAS assessment was significantly improved during the follow-up, as well as the sagittal and coronal radiographic parameters （LL, SS, PT, SVA, Cobb＇s angle, CTPL-CSVL）. The improvement of VAS and ODI of lumbar spine was significant correlated with sagittal parameters （LL, PT）, whilst not correlated with coronal parameters. Conclu- sion The surgical strategy of selective decompression and short-segment fusion with fixation is effective for the patients with symptomatic degenerative lumbar stenosis combined with lumbar scoliosis.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2017年第20期1256-1262,共7页
Chinese Journal of Orthopaedics
基金
国家自然科学基金面上项目（313709865）
关键词
腰椎
椎管狭窄
椎间盘退行性变
脊柱侧凸
减压术
外科
脊柱融合术
Lumbar vertebrae
Spinal stenosis
Intervertebral disc degeneration
Scoliosis
Decompression, surgical
Spinal fusion
