【摘要】 目的探讨成人脊柱侧凸手术治疗方法的选择及注意事项。方法选取2003年3月至2011年12月北京积水潭医院脊柱外科行成人脊柱侧凸手术治疗的97例患者,男36例,女61例,年龄21~77岁,平均61岁。97例患者均为国际脊柱侧凸研究会(SRS)成人脊柱侧凸分型系统5或6型,根据成人脊柱侧凸积水潭(JST)分型进一步细化分型,分为ⅠA1、ⅠA2、ⅠB1、ⅠB2、ⅡA1、ⅡA2、ⅡB1及ⅡB2共8种类型。随访2年,观察患者术前、术后和纠正后的腰部疼痛、下肢疼痛及下肢间歇性跛行缓解情况,采用Oswestry功能障碍指数(ODI)、Roland-Morris功能障碍问卷(RMDQ)、日本骨科协会评分(JOA)以及疼痛视觉模拟评分(VAS)等指标评估患者疼痛、感觉、运动功能障碍及生活功能。结果本研究包括ⅠA1型6例,ⅡA1型8例,ⅡB1型64例,ⅡA2型4例,ⅡB2型15例。ⅠA1型行单纯减压术,ⅡA1型和ⅡB1型行减压短节段内固定术、ⅡA2型和ⅡB2型行减压长节段侧凸矫形内固定术。41例患者行椎体间融合术(TLIF)辅助减压、矫形和内固定术;45例患者行术中导航辅助椎弓根螺钉植入。术前,无矫形组和矫形组患者Cobb角比较,差异无统计学意义(P>0.05),术后,2组Cobb角和矫正Cobb角比较,差异有统计学意义(P<0.05),手术前后各评分指标比较差异无统计学意义(P>0.05)。70岁以上患者术前有内科合并症的比例明显高于70岁以下的患者,术后6例发生内科并发症的患者均在70岁以上。结论成人脊柱侧凸的手术治疗,应根据不同患者的个体化情况选择合适的手术方案。成人脊柱侧凸的手术治疗并不是必须矫正侧凸,对于70岁以上的成人脊柱侧凸患者行手术治疗时要谨慎处理。利用TLIF技术有利于侧凸矫正、椎间孔减压及腰椎前凸的恢复,且术中导航技术辅助植入椎弓根螺钉有利于提高螺钉的植入精度。更多还原

【Abstract】 Objective To study how to select optimal surgical treatment for adult scoliosis. Methods A total of 97 patients who underwent surgery for adult scoliosis in Beijing Jishuitan Hospital from March 2003 to December 2011 was included in this study,36 males and 61 females,aged 21-77 years,with an average age of 61 years. The surgical methods and postoperative effects were analyzed. Ninety-Seven patients were all classified according Scoliosis Research Society( SRS) adult scoliosis classification system as type 5 or 6,and were further classified according JST scoliosis classification to:ⅠA1,ⅠA2,ⅠB1,ⅠB2,ⅡA1,ⅡA2,ⅡB1 and ⅡB2. After 2 years of follow-up,the pain of the lower back,the lower limb pain and the intermittent claudication of the lower limb were observed before and after the operation,the Oswestry disability index( ODI),Roland-Morris Disability Questionnaire disability questionnaire( RMDQ),Japanese Orthopedic Association( JOA) score,visual analogue scale( VAS) and other indicators were used to assess patients’ pain,sensation,motor dysfunction and life function. Results In this study,there were 6 cases of type ⅠA1,8 type ⅡA1,64 type ⅡB1,4type ⅡA2,15 type ⅡB2. Simple decompression was performed for type ⅠA1,Decompression and short segment fixation was performed for type ⅡA1 and ⅡB1. Decompression and long segmented fixation with scoliosis correction were performed for types ⅡA2 and ⅡB2. Forty one patients were operated with transforaminal lumbar interbody fusion( TLIF) to facilitate decompression,scoliosis correction and fixation. Forty five cases were operated with navigation to facilitate screws implant. There was no statistical significance of pre-operative Cobb ange between groups of scoliosis corrected and scoliosis non-corrcted( P > 0. 05). While there was statistical significance of post-operative Cobb angle between the 2 groups( P < 0. 05). But there was no statistical significance of pre-and post-operative evaluation parameters between the 2 groups( P > 0. 05). The incidence of preoperative medical complication in patients over 70 years of age was significantly higher than that in patients under age of70 years,and 6 cases with complications were all over 70 years old. Conclusion The selection of optimal surgical treatment for adult scoliosis is determined by individual condition of each patient. Not every adult scoliosis patient operated needs scoliosis correction. Operation for patients over 70 years old should be carefully prepared. TLIF technique can be help for scoliosis correction,intervertebral foramen decompression and getting normal lumbar lordosis. Navigation can increase accuracy of screw implant.更多还原