Lenke-Silva分型在退变性脊柱侧弯治疗的临床应用及疗效分析

发布时间：2018-01-18 02:21

  本文关键词：Lenke-Silva分型在退变性脊柱侧弯治疗的临床应用及疗效分析　出处：《宁夏医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 退变性脊柱侧弯 Lenke-Silva分型 临床疗效

【摘要】：目的评估并分析Lenke-Silva分型在国人退变性脊柱侧弯临床应用中的指导作用与意义,以期为国人退变性脊柱侧弯的临床诊疗提供理论参考。方法回顾性分析2011年3月--2014年9月在我院接受退变性脊柱侧弯手术治疗的患者65例。依据Lenke-Silva分型将所有病例资料进行分级,其中1级7例、2级14例、3级15例、4级13例、5级10例、6级6例。分型中1级病例行单纯减压;2级病例行后路减压并短节段融合固定;3级病例中3例行短节段融合固定,12例行侧弯矫形;4级病例中10例行后路减压、融合固定后凸矫形、恢复腰椎前凸,3例延伸固定至胸椎;5级行后路减压、矫形、长节段融合固定至胸椎9例,行截骨矫形1例;6级均行截骨矫形治疗。比较患者术前术后矢状面轴向垂线(sagittal vertical axis,SVA)、自然站立位时C7铅垂线至骶骨中线铅垂线偏移距离(central sacral vertical line distance,C7PL-CSVL)、腰椎Cobb角、前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence angle,PI)、骨盆倾斜角(pelvic tilt angle,PT)、骨盆入射角与腰椎前凸角匹配度(PI—LL)影像学参数的改变情况;将患者术前术后Oswestry功能障碍指数(ODI)、疼痛视觉模拟评分(visual analogue scale,VAS)、脊柱侧凸协会22项问卷表(scoliosis research society-22 SRS-22)评分进行比较,了解术后疼痛、功能及生活质量变化。结果所有患者均获得随访,最短随访11个月,最长随访4年,平均15.3月,所有患者术后6个月及末次随访疼痛、功能及生活质量评分(VAS、ODI、SRS-22)较术前比较均获得显著改善,统计学比较P0.05;影像学评估:1-2级患者术后6个月、末次随访Cobb角、腰椎前凸角、骨盆参数(PT、PI-LL)与术前比较无显著差异(P0.05);3-6级患者术后6个月、末次随访除骨盆入射角以外的所有影像学参数对比术前均有显著差异(p0.05)。结论依据Lenke-Silva分型为指导制定手术方案的全部退变性脊柱侧凸病例均取得了满意的临床疗效,该分型对于国人退变性脊柱侧弯的临床诊疗具有确切的指导意义,临床应用可行,实用性强,可作为国人退变性脊柱侧凸的临床分型和治疗决策制定的标准。
[Abstract]:Objective to evaluate and analyze the guiding role and significance of Lenke-Silva classification in the clinical application of degenerative scoliosis in Chinese. Methods 65 cases of degenerative scoliosis treated in our hospital from March 2011 to September 2014 were retrospectively analyzed in order to provide a theoretical reference for the clinical diagnosis and treatment of degenerative scoliosis. All cases were classified according to Lenke-Silva classification. There were 7 cases in grade 1, 14 cases in grade 2, 14 cases in grade 3, 15 cases in grade 4, 13 cases in grade 4, 10 cases in grade 5, 6 cases in grade 6. Grade 2 patients were treated with posterior decompression and short segment fusion fixation. Among the 3 grade cases, 3 cases were treated with short segment fusion fixation and 12 cases were treated with lateral bending correction. In 4 grade cases, 10 cases were treated with posterior decompression, fusion and fixation of kyphosis, and 3 cases with extension fixation to thoracic vertebra. In grade 5, posterior decompression, orthopedics, long segment fusion and fixation to thoracic vertebrae were performed in 9 cases, osteotomy in 1 case; All patients were treated with osteotomy and orthopedic surgery. The sagittal vertical axisus was compared before and after operation. The central sacral vertical line distance was located between the C7 lead perpendicular and the sacral midline when standing naturally. C7PL-CSVLA, Cobb angle of lumbar vertebrae, LLL (LLL). Pelvic incidence anglep, pelvic tilt anglePTT (pelvic angle of incidence). The changes of the imaging parameters of PI-LL in the matching of pelvic incidence angle with lumbar kyphosis angle; The preoperative and postoperative Oswestry dysfunction index and visual analogue scale were evaluated. Scoliosis research society-22 SRS-22 scores were compared to understand postoperative pain. Results all patients were followed up for the shortest 11 months, the longest follow-up 4 years (average 15.3 months). All patients were followed up 6 months and the last time. The scores of function and quality of life (VASA ODII SRS-22) were significantly improved compared with those before operation (P 0.05). Imaging evaluation showed that there was no significant difference in Cobb angle, lumbar kyphosis angle and pelvic parameters between preoperative and postoperative patients 6 months after operation (P 0.05). Patients with grade 3-6 were treated 6 months after operation. All the imaging parameters except the incidence angle of pelvis in the last follow-up were significantly different from those before operation (p 0.05). Conclusion all degenerative scoliosis cases with degenerative scoliosis under the guidance of Lenke-Silva classification have achieved satisfactory clinical results. This classification has definite guiding significance for the clinical diagnosis and treatment of degenerative scoliosis in Chinese. It is feasible and practical in clinical application. It can be used as the standard of clinical classification and treatment decision of degenerative scoliosis in Chinese.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R682.3
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