【摘要】 目的探讨腰椎退行性侧凸合并椎管狭窄症的临床特点及外科治疗方法。方法回顾性分析自2002年2月～2007年11月手术治疗并具有完整资料的52例退行性腰椎侧凸症43例。术前Cobb角平均为28.6°(22～47°),后正中切口,针对性减压"责任节段",切除椎间盘,扩大神经根管。应用平移、去旋转结合凹侧撑开、凸侧加压技术,适度矫正侧凸。结果本组获得6～72个月,平均15个月的随访。术后侧凸Cobb角7～14°,矫正度数15～30°,平均矫正率为58.7%。腰椎前凸角矫正为-46.5～-20.5°,平均-36.5°。其中术前JOA评分11分,术后1年随访为25分,优良率为88.6%。随访时未发现螺钉断裂、松动,无断棒现象。结论腰椎退行性侧凸外科治疗较为棘手,手术以解决"责任节段"为重点,融合固定是保证治疗效果的前提。更多还原

【Abstract】 Objective To investigate the clinical characteristics and surgical treatment of degenerative lumbar scoliosis complicated with spinal canal stenosis.Methods Clinical data of 52 patients(22 male and 30 female,age 47～72 years) with average preoperative Cobb angle 28.6°(angle range 22～47°) were analyzed retrospectively.In surgery,through posterior midline approach,laminectomy and decompression,intervertebral discectomy and enlargement of the nerve root canal were conducted.And then through translation and derotation technique combined with distraction in the convex side and compression in the convex side scoliosis was corrected to a proper degree.Results The follow-up time was 6～72 months,averaged 15 months.The postoperative Cobb angle range was 7～14°.The degree range of scoliosis correction was15～30°,and the average correction rate was 58.7%.The range degree of lumbar lordosis correction was-46.5～-20.5°,averaged-36.5°.JOA scores were improved from preoperative 11 to postoperative 25(after average 1 year follow-up),and the excellent and good rate was 88.6%.During the follow-up period no break or loosening of screw and break of rod was found.Conclusion The surgical treatment of degenerative lumbar scoliosis and spinal stenosis should be emphasized on the responsible segment,and firm fusion and fixation is the precondition of satisfactory outcome.更多还原