退变性腰椎侧凸合并多节段腰椎管狭窄的手术治疗

发布时间：2018-04-24 17:58

本文选题：退变性腰椎侧凸 + 腰椎管狭窄　；参考：《中国矫形外科杂志》2017年03期

【摘要】：[目的]探讨多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定治疗退变性腰椎侧凸合并多节段腰椎管狭窄的临床疗效。[方法]回顾分析2003年4月~2013年6月收治的35例退变性腰椎侧凸合并多节段腰椎管狭窄患者施行多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定术,必要时辅助对侧椎板间小开窗减压。术前腰椎Cobb角24.2°±9.6°,腰椎侧凸角21.2°±8.8°,VAS评分(8.4±1.9)分,JOA评分(11.3±4.2)分。评价术前、末次随访时腰椎Cobb角及腰椎前凸角的矫正及维持情况,根据术前、末次随访时VAS评分、JOA评分评价临床疗效。[结果]本组患者未出现死亡、瘫痪、中枢神经系统感染等严重并发症,肺部感染、泌尿系统感染、术口愈合不良、术后神经症状等经积极处理后均得到治愈。35例患者均获得随访,术后随访12~60个月,平均19个月。末次随访时腰椎Cobb角减小至9.2°±4.5°,腰椎前凸角增加至33.8°±8.6°,矫正率分别为61.9%、37.2%,较术前相比差异均有统计学意义(P0.05);末次随访时VAS、JOA评分分别为(2.8±1.5)分、(27.8±4.5)分,改善率分别为66.6%、93%,差异有统计学意义(P0.05)。[结论]多节段开窗椎管潜行扩大减压、椎体间及后外侧植骨融合内固定术,必要时辅助对侧椎板间小开窗减压治疗退变性腰椎侧凸合并多节段腰椎管狭窄安全,脊柱畸形的矫正和维持以及临床症状的改善令人满意。
[Abstract]:[objective] to investigate the clinical effect of multiple segmental fenestration in the treatment of degenerative lumbar scoliosis with multiple segmental spinal stenosis by decompression and fusion of interbody and posterolateral bone graft. [methods] from April 2003 to June 2013, 35 patients with degenerative lumbar scoliosis complicated with multilevel lumbar spinal canal stenosis were treated with multiple level fenestration decompression, interbody and posterolateral bone graft fusion and internal fixation. Assist in decompression of contralateral interlaminar small fenestration if necessary. The preoperative Cobb angle was 24.2 掳卤9.6 掳and the lumbar kyphosis angle was 21.2 掳卤8.8 掳. The correction and maintenance of lumbar Cobb angle and lumbar kyphosis angle were evaluated before and at the last follow-up. The clinical efficacy was evaluated according to the VAS score before and at the last follow-up. [results] there were no serious complications, such as death, paralysis, central nervous system infection, pulmonary infection, urinary system infection, poor healing of surgical mouth, etc. All the 35 patients were followed up after active treatment, and the follow-up was 12 ~ 60 months (mean 19 months). At the last follow-up, the Cobb angle of lumbar spine decreased to 9.2 掳卤4.5 掳, the kyphosis angle increased to 33.8 掳卤8.6 掳, and the correction rate was 61.9 卤37.2, which was significantly higher than that before operation (P 0.05), and at the last follow-up, the score of Cobb was 27.8 卤4.5), and the improvement rate was 66.6 卤93.The difference was statistically significant (P 0.05). [conclusion] it is safe to treat degenerative lumbar scoliosis with multiple segmental fenestration with enlarged decompression, fusion and internal fixation of interbody and posterolateral bone graft, and auxiliary decompression of contralateral interlaminar small fenestration in the treatment of degenerative lumbar scoliosis with multiple segmental spinal stenosis. The correction and maintenance of spinal deformity and the improvement of clinical symptoms are satisfactory.
【作者单位】：四川遂宁市中心医院骨科;解放军昆明总医院附属骨科医院全军创伤骨科研究所;
【分类号】：R687.3

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