腰后路手术治疗退行性腰椎侧凸并椎管狭窄疗效分析

Efficacy of surgical treatment for degenerative lumbar scoliosis with stenosis via posterior lumbar approach

摘要:

目的：评价腰后路减压、融合、椎弓根螺钉内固定术治疗退行性腰椎侧凸并椎管狭窄（degenerative lumbar stenosis with scoliosis，DLSS）的疗效。方法：回顾性研究我院2008年7月至2011年6月收治DLSS患者33例的临床资料，其中男11例，女22例，所有患者均采用腰后路减压、融合、椎弓根螺钉内固定术治疗。采用症状视觉模拟评估表（visual analog symptom rating scale，VAS）、Oswestry功能障碍指数评分表（Oswestry disability index，ODI）、腰椎冠状位Cobb角进行手术疗效评估。结果：全部病例获得随访，随访时间12～26个月，平均（17.27±3.78）月。术前患者平均VAS评分（7.00±0.90）分，ODI评分（70.61±7.29）%，Cobb角（20.58±9.96）°；末次随访患者平均VAS评分（3.00±0.97）分，ODI评分（31.42±9.22）%，Cobb角（6.12±3.22）°，术前术后差异具有统计学意义（P<0.05），ODI改善优良率为72.73% 。随访期间椎间隙高度无丢失，融合器无移位，内固定无断裂，植骨融合率100%。结论：后路减压、融合、椎弓根螺钉内固定术是一种治疗DLSS的有效手段。

Abstract:

Objective：To analyze the efficacy of posterior decompression，fusion，pedicle screw system fixation in the treatment of de－generative lumbar scoliosis with stenosis（DLSS）. Methods：Thirty-three patients with DLSS in our hospital from July 2008 to June 2011 were analyzed retrospectively，including 11 males and 22 females. All the patients were underwent posterior decompression，fusion，pedicle screw system fixation. Visual analog symptom rating scale（VAS），Oswestry disability index（ODI） and the Cobb angle on the lumbar coronal film were used for efficacy assessment. Results：All patients were followed up for 12-26 months，averaged（17.27±3.78） months. Mean preoperative VAS score，ODI score and Cobb angle were （7.00±0.90） points，（70.61±7.29）% and （20.58±9.96） degrees while those at the last follow-up were （3.00±0.97） points，（31.42±9.22）% and （6.12±3.22） degrees，with significant differences between preoperative and postoperative results（P<0.05）. Excellent rate of ODI was 72.73%. During the follow-up，the height of disc space was remained，fusion cage were not displaced，no case of internal fixations breakage was observed and rate of fusion for bone graft was 100%. Conclusions：Posterior decompression，fusion，pedicle screw system fixation is an effective surgical treatment for DLSS.