摘要
目的总结经后路治疗合并椎管狭窄退变性腰椎侧弯的诊治要点及治疗节段的选择。方法2001年2月-2006年9月,经后路治疗退行性腰椎侧凸性椎管狭窄23例。男9例,女14例;年龄52～71岁,平均65.3岁。病程4～8年。患者均有严重的下腰痛症状。按Bridwell分型,Ⅱ型13例,Ⅲ型10例。术前Cobb角17～53°,平均34°;腰椎前凸角(T12～S1)-20～-10°10例,-40～-20°13例,平均-20.7°。对Cobb角<20°的10例患者,行选择性椎管或神经根管减压,经后路椎体间融合,短节段椎弓根钉棒系统固定;对Cobb角>20°的13例患者,行椎管减压,长节段固定侧弯矫正,后路椎体间融合及后外侧自体骨植骨融合。固定及融合节段:L4～S1 6例,L1～5 5例,L2～5 4例,L1～S1 5例,L2～S1 2例,T10～S1 1例。结果患者无手术死亡。23例获随访6～54个月,平均15个月。21例(91%)术后神经根症状和间歇性跛行缓解明显;20例(87%)腰背痛缓解明显;3例足下垂患者逐渐恢复。术后冠状面Cobb角矫正为0～21°,平均15.6°,平均矫正率62%。腰椎前凸角矫正为-48.0～-18.2°,平均-36.4°。随访期内X线片示所有融合节段已愈合。1例患者术后12个月出现固定头端邻近节段椎间隙高度丢失,因无相应临床症状而未予特殊处理;3例术后仍有下腰痛,3个月后2例缓解,1例减轻。结论退变性腰椎侧弯治疗的首要目的是彻底神经减压,缓解临床症状;重建腰椎序列及稳定,是保证手术远期疗效的主要手段。固定和融合范围的选择,需综合考虑临床表现和影像学资料,个体化治疗。
Objective To discuss the main points of techniques and ranges of fusion in posterior operation of degenerated lumbar scoliosis complicated spinal stenosis. Methods From February 2001 to September 2006, 23 cases with degenerated lumbar scoliosis stenosis were treated by posterior operation. There were 9 males and 14 females, with the average age of 65.3 years （ranging from 52 years to 71 years）. The course of the diseases was 4 to 8 years. All patients were presented with severe low back pain. All patients were measured for Cobb angle of curves（17° to 53°）, and lordosis angle of lumbar （-20° to -10° 10 cases, -40° to-20° 13 cases）. Ten cases in which Cobb angle was smaller than 20° were operated by limited segmental decompression of spinal canal, posterior intervertebral fusion and short transpedical instrument fixation. For the rest 13 cases in which Cobb angle was bigger than 20° were operated by canal decompression, longer instrument for scoliosis correction, intervertebral fusion and posterior-lateral fusion. The fixation and fusion were located at L4-S1 in 6 cases, L1-5 in 5, L2-5 in 4, L1-S1 in 5, L2-S1 in 2 and T10-S1 in 1. Results There was no patient who died from the operation. Average Cobb angle in coronal plane was 0° to 21° with the average of 15.6°. The lumbar lordosis angle was -48.0° to- 18.2°with the average of -36.4°. There were 21 cases （91%） with sciatica and intermittent claudication who were clearly released. There were 20 cases （87%） whose low back pain intensely decreased. Three cases with drop-foot returned to normal activities. During the mean 15-month （6 to 54 months） follow-up for 23 cases, there was no change of corrected results and fusion rate was 100%. Conclusion For degenerated lumbar scoliosis patients, the most important purpose of the treatment is to improve clinical symptoms through sufficient decompression of neural structures. Lumbar stabilization reconstruction and benign spinal biomechanics line conduce to longterm curative effect. Overall estimate of the clinical appearances and imageology characters is necessary when the decision, that segments are needed to he fixed and fused should be made. The strategy of the individualized treatment may be the best choice.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2008年第6期711-714,共4页
Chinese Journal of Reparative and Reconstructive Surgery
