摘要
目的探讨经后路手术治疗成人退变性脊柱侧凸的中期临床效果。方法对我科2010年1月至2012年1月采用后路减压并固定融合手术治疗的36例退变性脊柱侧凸患者进行回顾性分析，影像学检查比较治疗前后冠状位Cobb角、腰椎前凸角及脊柱平衡改善情况，评价矫形效果，结合腰腿痛视觉模拟评分法（VAS）与Oswesty功能障碍指数（ODI）评价患者手术前后生活质量。结果36例患者包括男性11例，女性25例；年龄42-78岁，平均62．5岁。所有病例全程随访平均2．2年（1．5-3．5年）。患者术后各随访时间点影像学测量参数、腰腿痛VAS评分及ODI指数与术前相比差异均有统计学意义（P〈0．05）；与术后1年相比，手术2年后的末次随访腰痛VAS（1．96±0．90vs2．48±0．77，t=2．942，P〈0．05）与ODI（20．04±8．85vs26．48±6．99，t=3．648，P〈0．05）皆得到进一步改善。冠状面Cobb角矫正率为39．9％，腰椎前凸角平均增加约10°,末次随访时患者冠状面及矢状面平衡较术后1年得到进一步改善，差异具有统计学意义（P〈0．05）。围手术期切口感染3例，硬脊膜破裂3例，外周神经节功能异常5例，对症处理后皆获得满意疗效。1例患者减压后短节段融合术后1年半时脊柱侧凸加重，行延长固定节段的翻修手术后生活质量明显改善。末次随访影像学检查无断钉、断棒，无螺钉松动及假关节形成。结论采用经后路减压并固定融合责任节段手术治疗退变性脊柱侧凸，可明显缓解患者疼痛，提高其生活质量，相比短节段而言，长节段固定融合能较好纠正畸形的脊柱、延缓侧凸进展。虽然手术相关并发症较高，但通过积极对症支持治疗，皆可得到良好控制，并不影响手术疗效。
degenerative scoli Objective To evaluate the intermediate-term clinical outcome of the posterior surgery for osis. Methods Clinical data of 36 consecutive patients with degenerative scoliosis who were treated by posterior decompression and instrumented fusion surgery in our department from January 2010 to January 2012 were collected and retrospectively analyzed. Radiologic parameters including the coronal Cobb＇ s angle, lumbar lordosis angle, coronal and sagittal balance of spine, were recorded for the assessment of correc tion. The visual analogue scales （VAS） scoring for low back pain and sciatica, together with Oswestry disability index （ODI）, were applied to evaluate the preoperative and postoperative quality of life. Results All the patients were followed up for average 2.2 years （ range, 1.5 to 3.5 years） , including 25 women and 11 men with a mean age of 62.5 years （ range, 42 to 78 years）. There were significant differences between the pre- and post-operation in radiological parameters, VAS score and ODI （P 〈 0.05 ）. Comparing with the indexes in 1 year after the surgery, VAS score for low back pain （ 1.96 ± 0.90 vs 2.48 ± 0.77, t = 2. 942, P 〈 0.05 ） and ODI （20.04± 8.85 vs 26.48 ± 6.99, t = 3. 648, P 〈 0.05 ） turned out to be better at the final follow-up after the 2 years postoperatively. The correction rate of coronal Cobb＇ s angle was 39.9% , while the lumbar lordosis angle was increased by 10 on average after surgery. Coronal and sagittal balance at the final follow-up wereimproved from 1 year after operation （P 〈0.05 ）. Peri-operatively, 3 cases were compl]cateu wl,, uula 3 patients with superficial wound infection and 5 with peripheral root deficits. All of them obtained favorable outcomes after effective treatments. There was 1 case with curve progressed at 1.5 year after primary surgery of decompression and short fusion, lie got his quality of life improved significantly after accepting a revision with long instrumented fusion. At the final follow-up, no pedicle screw loosing, screw and rod breakage, or pseudar throsis was found in this cohort. Conclusion By means of posterior decompression and instrumented fusion surgery, patients with degenerative scoliosis can get absolute pain relief and improvement in quality of life. Compared with short fusion, long instrumented fusion leads to a better correction to halt the curve process. Although complications associated with the surgery are of high rate, these could be managed well with available intervention and don＇ t weaken the curative effect.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2014年第7期716-720,共5页
Journal of Third Military Medical University
关键词
退变性脊柱侧凸
后路减压并固定融合
生活质量
并发症
degenerative scoliosis
posterior decompression and instrumented fusion
quality of life
complication
