成人退变性脊柱侧弯长节段固定融合的近期疗效评价

发布时间：2019-06-01 23:40

【摘要】：目的:评价长节段固定融合手术治疗成人退变性脊柱侧弯(ADS)的近期临床疗效,探索合理的治疗方案。方法:选取江西省人民医院骨一科在2012年1月-2016年6月收治的ADS患者29人,术前根据拍摄的站立位脊柱正侧位片均测量侧弯cobb角、腰椎前凸角,并记录VAS评分、JOA评分、ODI指数。所有患者均采用后路椎弓根钉棒内固定手术,术中对出现神经症状节段充分减压。记录手术时间、出血量、手术的相关并发症情况。术后拍摄脊柱正侧位片,对术后约1周侧弯cobb角、腰椎前凸角进行测量,并记录术后1周VAS评分、JOA评分、ODI指数。出院后至门诊定期复查摄脊柱正侧位片,测量手术3月后侧弯cobb角、腰椎前凸角,记录VAS评分、JOA评分、ODI指数。对结果进行统计学分析。结果:29例患者手术均顺利完成,术后安全返回病房。术后患者腰痛明显减轻,生活质量明显改善,下肢放射痛患者均不同程度减轻,间隙性跛行均得到改善,3例仍感觉原有的下肢区域麻木。其中2例术后出现切口渗液,给予抗感染无效,再次手术清创探查,考虑同种异体骨排斥反应,术中取出同种异体骨,术后切口愈合良好;其余患者未再行探查手术,1例术中硬膜破裂,术中行硬膜修补,术后出现脑脊液漏;另还有1例出现脑脊液漏,予以延长引流时间,头低脚高体位、压迫伤口,并定期予以伤口换药,切口愈合良好。1例术后出现呼吸困难,请相关科室会诊,完善肺动脉造影考虑为肺动脉分支的终末支栓塞,治疗后恢复良好。3例出现肺部感染,经抗感染后明显好转。1例出现泌尿系感染,予以抗感染后情况好转。术后1周与手术前相比,术后1周侧弯cobb角、腰椎前凸角明显纠正(P0.05),术后1周VAS评分、JOA评分及ODI指数较术前有明显提升(P0.05)。术后3个月与术后1周相比,术后3个月侧弯cobb角有轻度丢失(P0.05),腰椎前凸角无明显变化(P0.05),术后3个月时与术后1周相比,术后3个月VAS评分、JOA评分、ODI指数改善明显(P0.05)。结论:对于侧弯角度较大、存在一定功能障碍的ADS患者,选用长节段固定手术近期的腰背痛可明显减轻,下肢功能可得到明显改善;对于恢复脊柱的矢状面腰椎前凸角、冠状面平衡作用明显。
[Abstract]:Objective: to evaluate the short-term clinical effect of long segment fixation fusion surgery in the treatment of adult degenerative scoliosis (ADS) and to explore a reasonable treatment scheme. Methods: from January 2012 to June 2016, 29 patients with ADS were treated in the Department of Bone, Jiangxi Provincial people's Hospital. the cobb angle and lumbar protruding angle of lumbar vertebrae were measured according to the anterior and lateral films of standing position before operation, and the VAS score and JOA score were recorded. ODI index. All patients were treated with posterior pedicle screw internal fixation, and the segments with neurological symptoms were fully decompressed during the operation. The operation time, the amount of bleeding and the complications related to the operation were recorded. The cobb angle and lumbar kyphosis angle were measured at about 1 week after operation, and the VAS score, JOA score and ODI index were recorded one week after operation. After discharge from hospital to outpatient department, the anterior and lateral films of spine were taken regularly. Cobb angle and lumbar protruding angle were measured after 3 months of operation. VAS score, JOA score and ODI index were recorded. The results were analyzed statistically. Results: all the 29 patients completed the operation successfully and returned to the ward safely after operation. After operation, low back pain was significantly alleviated, quality of life was significantly improved, radiation pain of lower extremity was alleviated in varying degrees, intermittent claudication was improved, and 3 cases still felt numbness of lower extremity area. Among them, 2 cases had incision exudation after operation, which was ineffective in anti-infection, debridement and exploration again, considered allogenic bone rejection, and took out allogenic bone during operation, and the incision healed well after operation. No further exploration operation was performed in the other patients. 1 case underwent dural rupture during operation, dural repair was performed during operation, and cerebrospinal fluid leakage occurred after operation. In addition, cerebrospinal fluid leakage occurred in 1 case. The drainage time was prolonged, the head was low and the foot was high, the wound was pressed, and the wound was changed regularly. The incision healed well. 1 case had dyspnea after operation, please consult the relevant departments. Pulmonary angiography was considered as the terminal branch embolism of pulmonary artery branch, and recovered well after treatment. 3 cases had pulmonary infection, which was obviously improved after anti-infection. 1 case had urinary tract infection, and the condition was improved after anti-infection. Compared with before operation, the cobb angle and lumbar protruding angle were significantly corrected 1 week after operation (P 0.05). The VAS score, JOA score and ODI index 1 week after operation were significantly higher than those before operation (P 0.05). Compared with 1 week after operation, the cobb angle of lateral bending was slightly lost at 3 months after operation (P 0.05), but there was no significant change in lumbar protruding angle (P 0.05). Compared with 1 week after operation, VAS score and JOA score at 3 months after operation were not significantly changed (P 0.05). ODI index improved significantly (P 0.05). Conclusion: for ADS patients with large lateral bending angle and certain dysfunction, the short-term low back pain and lower extremity function can be obviously alleviated by long segment fixation. For the restoration of sagittal lumbar protruding angle, coronal balance is obvious.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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