【摘要】 目的评估后路减压联合椎间融合治疗腰椎退变性侧凸的临床疗效,探讨腰椎退变性侧凸的手术策略。方法回顾性分析手术治疗腰椎退变性侧凸患者98例,男35例,女63例;平均年龄(56±9)岁;平均侧凸Cobb角为(26±9)°;平均腰椎前凸为(19±11)°。采用后正中入路,行责任节段减压联合椎间融合内固定治疗。采用JOA29分标准进行临床疗效评定以及Cobb角和腰椎前凸角变化来评价手术疗效。结果平均随访时间(3.7±2.4)年。术前JOA评分为(10±2)分,提高到末次随访时的(26±3)分;优良率为89.7%。无患者术后症状加重,所有患者均感觉较术前症状明显减轻。平均椎间达骨性融合时间为(5.7±1.4)个月。末次随访时X线片示平均腰椎侧凸Cobb角为(6±2)°,平均矫正度数为(17±4)°,矫正率为59.2%;平均腰椎前凸矫正度数为(12±3)°。无内固定断裂和松动;钛合金cage轻度后侧移位2例,无不适症状,未做处理。结论对于有临床症状的退变性腰椎侧凸,且保守治疗无效的患者,采用后路减压联合椎间融合治疗可以取得满意的临床疗效。但责任节段的确定、减压充分和恢复腰椎稳定性是长期疗效的保证。更多还原

【Abstract】 Objective To assess the clinical outcomes of posterior decompression and lumbar interbody fusion with internal fixation treatment for degenerative lumbar scoliosis(DLS). Methods Ninety-eight patients underwent surgery for DLS were retrospectively reviewed in this study. The mean age of the patients(male 35 and femail 63) was(56±9) years. The mean Cobb angle of curves was(26±9)° and the mean scoliosis Cobb angle of lumbar was(19±11)° in patients before surgery. A posterior medial incision was made for spinal exposure. According to the preoperative plan,patients were operated with posterior decompression and lumbar interbody fusion with internal fixation. The clinical outcomes were assessed by the JOA scores.The preoperative and postoperative Cobb angle was recorded. Results The mean follow-up time was(3.7±2.4) years. The mean JOA scores were improved from(10±2) points preoperatively to(26±3) points at the last follow-up. The excellent or good outcome rates were 89.7% for patients with surgery. The average interbody fusion time was(5.7±1.4) months. The mean postoperative Cobb angle was(6±2)° at the last follow-up,and the mean Cobb angle correction was(17±4)°,with the correction rate of 59.2%. The mean lumbar lordosis angle was(12±3)°. There was no failure in internal fixation. Conclusion The posterior decompression and lumbar interbody fusion with internal fixation appears to be a reasonable option for degenerative lumbar scoliosis.更多还原