摘要
目的:探讨单纯椎板减压治疗退变性椎管狭窄症并腰椎侧凸的效果及其影响因素。方法:1996年～2000年我科收治的资料完整的退变性椎管狭窄症合并腰椎侧凸患者57例,均采用单纯腰椎椎板减压术治疗。使用JOA评分标准进行疗效评价,根据JOA评分恢复率(recover rate,RR)将患者分为效果满意组(RR≥50%)和效果不满意组(RR<50%),对腰椎前凸角、侧凸角、腰椎活动度以及L4椎体倾斜率和侧向位移等影像学参数与临床治疗效果的关系进行统计分析。结果:本组随访3～7年,平均5.1年,效果满意者42例,不满意者15例,统计分析显示腰椎前凸、活动度、L4椎体的倾斜率和手术减压节段对手术效果有显著影响(P<0.05),与效果不满意组相比,疗效满意组患者术前腰椎前凸小,活动度低,L4椎体倾斜率不明显,需要手术减压的节段少。结论:对腰椎前凸较小、活动度低和L4椎体倾斜率较小的椎管狭窄症合并腰椎侧凸的患者使用短节段全椎板减压可以获得满意的疗效。
Objective：To evaluate the clinical validity of laminectomy for the treatment of lumbar spine stenosis associated with degenerative scoliosis and search radiographic predictors.Method：From 1996-2000,57 cases（29 males and 28 females） admitted to our department as lumbar stenosis complicated with degenerative scoliosis were reviewed retrospectively.Their clinical manifestations and radiographic documents had been followed up successfully through out-patient clinic.All cases underwent laminectomy alone for treatment and the clinical outcomes were evaluated by Japanese Orthopedic Association（JOA） score and recovery rate（RR） system.According to the RR standard,patients in our series were divided into two groups,satisfactory group and unsatisfactory group.X-ray parameters including lumbar spine lordosis angle,scoliosis angle,ROM of lumbar spine,oblique rate of L4 and lateral translation were compared and analyzed with software package PEMS 3.1. Result：The mean follow-up period was 5.1 years （range,3-7 years）,42 cases were classified into satisfactory group and 15 cases into unsatisfactory group,the JOA score improved form 15.2±3.7 preoperative to 22.3±4.7 at the final follow-up.Statistic analysis revealed that the number of decompressed segments,L4 obliquity angle,lumbar lordosis and the range of lumbar movement （ROM） on the lateral X-ray image were significantly correlated with the clinical results （P〈0.05）.The satisfactory group had less lumbar spine lordosis angle,less ROM,less oblique rate of L4 and less decompression segments than those in unsatisfactory group.Conclusion： Short-segment laminectomy is a simple and effective modality for the treatment of lumbar stenosis combined with degenerative lumbar scoliosis especially for those who have less L4 obliquity angle,less lumbar spine lordosis angle and ROM.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
2007年第7期494-498,共5页
Chinese Journal of Spine and Spinal Cord
