摘要
[目的]探讨多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定治疗退变性腰椎侧凸合并多节段腰椎管狭窄的临床疗效。[方法]回顾分析2003年4月~2013年6月收治的35例退变性腰椎侧凸合并多节段腰椎管狭窄患者施行多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定术,必要时辅助对侧椎板间小开窗减压。术前腰椎Cobb角24.2°±9.6°,腰椎侧凸角21.2°±8.8°,VAS评分(8.4±1.9)分,JOA评分(11.3±4.2)分。评价术前、末次随访时腰椎Cobb角及腰椎前凸角的矫正及维持情况,根据术前、末次随访时VAS评分、JOA评分评价临床疗效。[结果]本组患者未出现死亡、瘫痪、中枢神经系统感染等严重并发症,肺部感染、泌尿系统感染、术口愈合不良、术后神经症状等经积极处理后均得到治愈。35例患者均获得随访,术后随访12~60个月,平均19个月。末次随访时腰椎Cobb角减小至9.2°±4.5°,腰椎前凸角增加至33.8°±8.6°,矫正率分别为61.9%、37.2%,较术前相比差异均有统计学意义(P<0.05);末次随访时VAS、JOA评分分别为(2.8±1.5)分、(27.8±4.5)分,改善率分别为66.6%、93%,差异有统计学意义(P<0.05)。[结论]多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定术,必要时辅助对侧椎板间小开窗减压治疗退变性腰椎侧凸合并多节段腰椎管狭窄安全,脊柱畸形的矫正和维持以及临床症状的改善令人满意。
[Objective] To investigate the outcomes of multilevel fenestration and deeompression of spinal canal, interbody fusion and posterolateral bone graft fusion, as well as internal fixation for the treatment of degenerative lumbar scoliosis （DLS） associated with multilevel lumbar spinal stenosis. [Methods] A total of 35 cases of DLS associated with multilevel lumbar spinal stenosis who were admitted to our hospital from April 2003 to June 2013 were retrospectively analyzed. The patients received multilevel fenestration and decompression of spinal canal, interbody fusion and posterolateral bone graft fusion as well as internal fixation, and adjuvant fenestration and decompression were applied to the lateral vertebral plate if necessary. The preoperative Cobb angle of lumbar spine was 24.2°±9.6°, the lateral convex angle was 21.2°±1.2°, the Visual Analogue Scale （VAS） score was 8.4±1.9, and the Japanese Orthopedic Association （JOA） score was 11.3±4.2. The correction and maintenance of Cobb angle and lordosis angle of the lumbar spine were evaluated before operation and at the last follow-up. The clinical efficacy was assessed based on VAS score and JOA score before operation and at the last follow-up. [Results] No serious complications like death, paralysis, and central nervous system infection occurred in the patients, and pulmonatr in-fection, urinary system infection, poor healing of surgical wound, and postoperative nervous symptoms were all cured with active treatment. A total of 35 patients were followed up from 12 to 60 months, with an average of 19 months. At the last follow-up, the Cobb angle of the lumbar spine was reduced to 9.2°±4.5°, and the lordosis angle of the lumbar spine was increased to 33.8°± 8.6°, with correction rates of 61.9% and 37.2%, respectively. Compared with those before operation, the values after operation were significantly different （P 〈0.05） . At the last follow-up, the VAS and JOA scores were （2.8±1.5） and （27.8±4.5） , respectively, with improvement rates of 66.6% and 93%, respectively, and the differences were statistically significant （P 〈0.05） . [Conclusions] Multilevel fenestration and decom- pression of spinal canal, interbody fusion and posterolateral bone graft fusion, as well as internal fixation is safe in Ihe treatment of degenerative DLS associated with muhilevel lumbar spinal stenosis, and can achieve satisfactory results in correcting and maintaining spinal deformity and improving clinical symptoms.
作者
兰家平
汤逊
徐永清
李阳
汪凡栋
张智
郑佳状
冉茂波
LAN Jia-ping TANG Xun XU Yong-qing et al(Department of Orthpedics, Suining Central Hospital, Sichuan Suining 629000, Chin)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2017年第3期204-208,共5页
Orthopedic Journal of China
关键词
退变性腰椎侧凸
腰椎管狭窄
减压
融合
degenerative lumbar scoliosis, lumbar spinal stenosis, decompression, fusion
