摘要
目的 探讨退变性腰椎侧凸（degenerative lumbar scoliosis，DLS）并多节段腰椎管狭窄的手术指征、减压融合技术及固定节段的选择。 方法2000年4月－2011年11月，采用多节段开窗椎管潜行扩大减压联合椎体间及后外侧植骨融合内固定术（5节段或以上）治疗46例DLS并多节段腰椎管狭窄患者。其中男25例，女21例；年龄65～81岁，平均70.2岁；病程4年6个月～13年，平均6.4年。X线片示腰椎Cobb角（26.7 ± 10.0）°，腰椎前凸角（20.3 ± 8.8）°；腰椎CT及MRI检查示3节段狭窄24例，4节段狭窄17例，5节段狭窄5例。共165个狭窄节段，分别位于L1、 2 12个，L2、3 34个，L3、4 43个，L4、5 45个，L5、S1 31个。手术前后采用疼痛视觉模拟评分（VAS）、 Oswestry功能障碍指数（ODI）及日本骨科学会（JOA）腰椎功能评分29分法评价疗效。 结果术中13例出现脑脊液漏，经相应处理后未出现严重感染。术后4例肺部感染、2例泌尿系统感染，予以抗感染治疗缓解；8例切口愈合不良，给予换药、充分引流、清创缝合，均治愈。无死亡、瘫痪、中枢神经系统感染等严重并发症发生。46例均获随访，随访时间12～72个月，平均36.2个月。患者腰背痛、间歇性跛行及下肢疼痛麻木症均状较术前明显缓解。随访期间X线片及CT扫描三维重建均未见螺钉切割、松动、断钉、断棒及固定节段假关节形成。末次随访时，腰椎Cobb角减小至（9.8 ± 3.6）°，腰椎前凸角增大至（34.1 ± 9.4）°，均较术前显著改善（t=16.935，P=0.000；t=15.233，P=0.000）。末次随访时VAS、ODI及JOA评分分别为（3.2 ± 1.2） 分、35.5% ± 14.0%和（26.6 ± 5.7）分，均较术前的（8.0 ± 2.2）分、60.8% ± 13.3%和（12.9 ± 3.4）分显著改善（t=19.857，P=0.000；t=16.642，P=0.000；t=15.922，P=0.000）。 结论多节段开窗椎管潜行扩大减压联合椎体间及后外侧植骨融合内固定术治疗DLS并多节段腰椎管狭窄，有利于解除神经压迫、重建脊柱平衡、提高患者生活质量，是一种有效方法。
Objective To explore the surgical indications, decompression and fusion method, and fusion level selection of degenerative lumbar scoliosis （DLS） and multi-segment lumbar spinal stenosis. Methods Between April 2000 and November 2011, 46 cases of DLS and multi-segment lumbar spinal stenosis were treated with multi-level decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion （5 segments or above）. Of 46 cases, 25 were male and 21 were female, with a mean age of 70.2 years （range, 65-81 years） and with a mean disease duration of 6.4 years （range, 4 years and 6 months to 13 years）. X-ray films showed that the lumbar Cobb angle was （26.7 ± 10.0）°, and the lumbar lordotic angle was （20.3 ± 8.8）°. The lumbar CT and MRI images showed three-segment stenosis in 24 cases, four-segment stenosis in 17 cases, and five-segment stenosis in 5 cases. A total of 165 stenosed segments included 12 L1, 2, 34 L2, 3, 43 L3, 4, 45 L4, 5, and 31 L5 and S1. Visual analogue scale （VAS） score, Oswestry disability index （ODI）, and Japanese Orthopedic Association （JOA） score （29 points） were employed to evaluate effectiveness. Results Thirteen patients had leakage of cerebrospinal fluid during operation, and no infection was found after corresponding treatment; pulmonary infection and urinary system infection occurred in 4 and 2 patients respectively, who relieved after received antibiotic therapy; 8 patients with poor wound healing received dressing change, adequate drainage, debridement and suture. No death, paralysis, central nervous system infection, or other complication was observed in these patients. Forty-six cases were followed up 12-72 months （mean, 36.2 months）. Lumbago and backache and intermittent claudication of lower extremity were obviously improved. During follow-up, no screw incising, loosening and broken screws, or pseudarthrosis was noted under X-ray film and CT scanning. At last follow-up, the lumbar Cobb angle was reduced to （9.8 ± 3.6）°, while the lumbar lordotic angle was increased to （34.1 ± 9.4）°, which were significantly improved when compared with preoperative ones （t=16.935, P=0.000;t=15.233, P=0.000）. At last follow-up, VAS, ODI, and JOA scores were 3.2 ± 1.2, 35.5% ± 14.0%, and 26.6 ± 5.7 respectively, showing significant differences when compared with preoperative scores （8.0 ± 2.2, 60.8% ± 13.3%, and 12.9 ± 3.4） （t=19.857, P=0.000;t=16.642, P=0.000;t=15.922, P=0.000）. Conclusion Multi-segment decompression by fenestration and crept enlargement plus internal fixation by interbody and posterior-lateral bone graft fusion is helpful to relieve nerve compression symptoms, rebuild spinal balance, and improve the life quality of the patients. It is a very effective way to treat DLS and multi-segment lumbar spinal stenosis.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2014年第8期960-964,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
退变性腰椎侧凸
多节段腰椎管狭窄
后路手术
多节段减压
融合
Degenerative lumbar scoliosis
Multi-segment lumbar spinal stenosis
Posterior approach
Multi-segment decompression
Fusion
