【摘要】 目的 评价后路有限减压、固定、融合手术治疗退行性腰椎侧凸合并椎管狭窄症的疗效。方法 2001年1月至2008年1月，收治退行性腰椎侧凸合并椎管狭窄症患者36例，男2例，女34例；年龄51～76岁，平均62.3岁；合并椎管狭窄症病程10个月～7年，平均37个月。所有患者术前均行X线、CT及MR检查， 5例患者行脊髓造影。术前Cobb角为24.0°±10.2°，腰椎前凸角22.6°±11.2°，C7铅垂线（C7PL）与S1椎体后上缘距离（SVA）（7.8±6.6） cm，C7PL与骶正中线距离（CSVL）（6.9±5.8） cm。患者采用后路有限减压、固定、融合手术进行治疗。术后进行随访，采用VAS、SF-36评分系统进行疗效评估。结果 手术时间115～164 min，平均130 min；出血量450～870 ml，平均625 ml。所有患者均获得随访，随访时间1.2～4年，平均2.4年。患者术后、末次随访平均Cobb角10.6°±8.5°、8.9°±5.3°，腰椎前凸角25.6°±14.3°、31.8°±13.4°，SVA（0.5±3.4） cm、（-1.2±2.7） cm，CSVL（2.9±1.4） cm、（1.7±1.2） cm，较术前均具有显著性差异。术后仅1例患者发生矫正丢失，无一例发生椎间隙塌陷、神经损伤、钉棒断裂等并发症。结论后路有限减压、固定、融合手术是治疗退行性腰椎侧凸合并椎管狭窄症的有效手段。
    【关键词】 腰椎； 椎管狭窄； 脊柱侧凸
    【证据等级】 治疗性研究Ⅳ级

 

    Limited decompression, fixation, and fusion for degenerative scoliosis with vertebral stenosis DING Wen-yuan, GUO Zhao, SHEN Yong, et al. Spine Service, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
    【Abstract】 Objective To evaluate the efficiency of limited decompression, fixation, and fusion for degenerative scoliosis with vertebral stenosis. Methods From January 2001 to January 2008, 36 patients with degenerative scoliosis with vertebral stenosis were treated in our hospital. There were 2 males and 34 females. The age was from 51 to 76 years with an average of 62.3 years. X-ray, CT, MR examination were performed preoperatively for all the cases, 5 cases underwent myelography. Preoperative Cobb's angle, focal lordosis, the distance between C7 plumb line(C7PL) and upper edge of S1 vertebral body (SVA), and the distance between C7PL and center sacral vertical line(CSVL) were 24.0°±10.2°, 22.6°±11.2°, （7.8±6.6） cm and (6.9±5.8) cm respectively. Limited decompression, pedicle screw internal fixation and fusion were carried out for patients, VAS and SF-36 scored system were used to evaluate surgery effects. Results The mean follow-up period was 2.4 years(range, 1.2-4 years) and no patients were lost during follow-up. The mean surgery time was 130 min （range, 115-164 min） with an average bleeding amount of 625 ml(range， 450-870 ml). Compared to preoperation， Cobb's angle(10.6°±8.5°, 8.9°±5.3°), focal lordosis(25.6°±14.3°, 31.8°±13.4°), SVA［（0.5±3.4） cm, （-1.2±2.7） cm］, and CSVL ［（2.9±1.4） cm, （1.7±1.2） cm］ were significantly improved at postoperation and final follow-up through statistics of SPSS 13.0 software. Loss of correction happened in one case. No collapse of the disc height occurred, neither did nerve root injuries nor fracture of the fixation system. Conclusion Limited decompression, pedicle screw fixation and fusion are testified efficient for degenerative scoliosis with vertebral stenosis, individualized surgery design should be made according to clinical symptoms, signs and imaging features to expect a satisfactory result.
    【Key words】 Lumbar vertebrae; Spinal stenosis; Scoliosis