【摘要】 目的探讨成年人腰椎退变侧凸的手术治疗策略及临床疗效。方法对近5年收治的18例成年人症状性腰椎退变侧凸患者,采用后路选择性椎管及神经根管减压、全节段椎弓根螺钉内固定融合术。本组行腰1~5椎弓根内固定2例,腰2~5椎弓根内固定6例,腰2~骶1椎弓根内固定4例,腰3~骶1椎弓根内固定6例;椎板间开窗2例,半椎板切除6例,全椎板切除10例,所有患者术中均行症状侧神经根管扩大;固定节段横突间融合2例,减压节段椎间加固定节段横突间融合8例,减压节段椎间加后外侧融合8例。结果所有患者均获随访6~46个月,平均18个月,术后原有临床症状均明显缓解,按JOA评分,手术疗效优良率92.5%,侧凸平均矫正率53.9%。随访期间无内固定松动断裂,椎间高度及畸形矫正无明显丢失,植骨融合平均时间5.6个月。结论后路椎管及神经根管减压、全节段椎弓根内固定融合术,是治疗成年人症状性腰椎退变侧凸的有效方法,减压和内固定融合是取得良好临床疗效的关键,畸形的矫正应适可而止。更多还原

【Abstract】 Objective To discuss the therapeutic strategy and clinical effect of the adult degeneration lumbar scoliosis by surgical treatment.Methods In recent 5 years 18 cases of adult patients with symptomatic lumbar degeneration were operated by selective spinal canal and nerve root canal decompression with all segmental pedicle screw internal fixation.In this group,2 cases with the pedicle screw internal fixation from L1to L5,6 cases with the pedicle screw internal fixation from L2to L5,4 cases with the pedicle screw internal fixation from L2to S1,6 cases with the pedicle screw internal fixation from L3to S1.According to the different symptoms and imaging findings,2 cases were done through fenestration,6 cases were done through semi-laminectomy,10 cases were done through total- laminectomy.All the patients with the symptomatic contralateral side were decompressed nerve root canal.In this group,2 cases with the intertransverse fusion,8 cases with the intervertebral fusion and intertransverse fusion,8 cases with the intervertebral fusion and posterolateral fusion.Results All cases were followed up for 6 ~ 46 months,and average of 18 months.The original clinical symptoms were significantly alleviated after operation.The excellent rate was 95.2% by the JOA score.The average rate of scoliosis correction reached 53.9%.During the follow-up period,no internal fixation loosening or breakage case was found,without notable correction loss of intervertebral height and deformity correction.The average time of bone-grafting fusion was 5.6 months.Conclusion It is an effective way to treat adult degeneration lumbar scoliosis by the vertebral canal and nerve root canal decompression and all segmental pedicle internal fixation.Decompression and internal fixation of fusion is the key to achieve good clinical efficacy.Deformity correction should be appropriately.更多还原