长节段固定融合治疗退变性脊柱侧凸的中期疗效

发布时间：2018-02-13 18:13

本文关键词： 退行性脊柱侧凸长节段固定融合潜行减压并发症　出处：《中国现代医学杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的评价长节段固定融合治疗退变性脊柱侧凸的中期疗效。方法回顾性分析2007年1月-2012年12月行长节段固定融合治疗的25例退变性脊柱侧凸患者采用视觉模拟评分(VAS)、日本骨科协会(JOA)评分、腰椎前凸角和冠状位Cobb角评价术后3个月、1~2年及2年以上的临床疗效。结果4例发生术中硬膜囊撕裂均于术中给予修复;术后切口均Ⅰ期愈合,无发生感染者。3例出现螺钉松动或断裂,2例出现邻近节段疾病均出现在术后≥2年经第二次手术治疗效果好。植骨粒延迟愈合1例对症治疗后愈合。所有患者均获得2年以上有效随访,随访时间2~7年(平均3.8年)。末次随访时VAS评分和JOA评分较术前仍有明显改善(t=14.235和-11.244,P=0.000)。冠状位Cobb角术后3个月较术前有改善(t=12.329,P=0.000),但术后1年以上较术前没有改善(t=1.106,P=0.280)。术后腰椎前凸角度较术前无明显变化(t=-1.932,P=0.065)。结论长节段固定融合术式治疗退行性脊柱侧凸达到充分减压的同时,可以覆盖整个曲线实现固定、融合以及重建脊柱稳定性的目的,进而阻止退行性脊柱侧凸的进展,取得良好的中期疗效。
[Abstract]:Objective to evaluate the effect of long segment fixation fusion in the treatment of degenerative scoliosis. Methods 25 patients with degenerative scoliosis from January 2007 to December 2012 were analyzed retrospectively. Vasan, Japan Orthopedic Association (JOAA) score, The clinical effects of lumbar kyphosis angle and coronal Cobb angle were evaluated for 1 ~ 2 years and more than 2 years after operation. Results all the 4 cases of intraoperative dural sac tear were repaired during operation. No infection occurred in 3 cases, screw loosening or breakage occurred in 2 cases, adjacent segment disease occurred in 2 or more years after operation. Delayed healing of bone grafts was achieved in 1 case after symptomatic treatment. All the patients were all healed. Effective follow-up for more than 2 years, The follow-up time ranged from 2 to 7 years (mean 3.8 years). At the last follow-up, the VAS score and JOA score were still significantly improved compared with those before operation. The coronal Cobb angle was improved at 3 months after operation compared with that before operation. The angle of lumbar kyphosis had no significant change compared with that before operation. Conclusion the treatment of degenerative scoliosis with long segment fixation fusion has achieved full decompression at the same time. It can cover the whole curve to achieve the purpose of fixation, fusion and reconstruction of spinal stability, thus preventing the progression of degenerative scoliosis and achieving a good medium-term effect.
【作者单位】：华北理工大学研究生学院;河北省唐山市第二医院脊柱一科;
【分类号】：R687.3

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