CAJ | 학술논문

目的回顾性分析根据不同程度成人退行性腰椎侧凸采用不同术式治疗后的中远期疗效.方法自1998年5月至2002年11月手术治疗31例成人退行性腰椎侧凸患者.平均年龄55.8岁(45～71岁).全部患者共分4组:A组为腰椎冠状位畸形较轻、矢状位畸形明显者13例;B组为腰椎冠状位畸形明显、矢状位畸形轻微,行椎管减压、内固定植骨融合术者5例;C组为腰椎冠状位、矢状位均畸形严重,行后路椎管减压、冠状位原位融合、矢状位矫形内固定植骨融合术者5例;D组为腰椎冠状位、矢状位轻微畸形伴腰椎管狭窄,行单纯减压者8例.所有病例术后至少随访5年,收录临床结果和影像学资料.术前、术后1年和5年所有患者完成Oswestry下腰痛功能障碍问卷调查表.结果 30例患者全程随访,平均随访74个月(60～94个月).内固定组患者术后1年较术前冠状位、矢状位Cobb角显著改善(q=10.125,P＜0.05),术后1年和术后5年差异无统计学意义(q=1.031,P＞0.05);术后5年,单纯减压组(D组)腰椎冠状位Cobb角较术前呈增大趋势(q=3.071,P＞0.05),矢状位Cobb角呈减小趋势(q=0.928,P＞0.05).所有患者术后1年ODI评分功能障碍指数较术前显著改善(12.4±7.69比56.8±13.2,q=6.453,P＜0.05);术后5年较术后1年略有反弹,但仍显著优于术前(24.9±5.3比12.4±7.69,q=8.148,P＜0.05).结论退变性腰椎侧凸手术治疗的主要目的为彻底减压、重建矢状面和冠状面力学平衡.尽管成人退行性脊柱侧凸临床情况复杂多变,按照不同患者具体畸形情况、根据个体化原则,合理选择术式,可以有效改善患者生活质量.
목적 회고성분석근거불동정도성인퇴행성요추측철채용불동술식치료후적중원기료효.방법 자1998년5월지2002년11월수술치료31례성인퇴행성요추측철환자.평균년령55.8세(45～71세).전부환자공분4조:A조위요추관상위기형교경、시상위기형명현자13례;B조위요추관상위기형명현、시상위기형경미,행추관감압、내고정식골융합술자5례;C조위요추관상위、시상위균기형엄중,행후로추관감압、관상위원위융합、시상위교형내고정식골융합술자5례;D조위요추관상위、시상위경미기형반요추관협착,행단순감압자8례.소유병례술후지소수방5년,수록림상결과화영상학자료.술전、술후1년화5년소유환자완성Oswestry하요통공능장애문권조사표.결과 30례환자전정수방,평균수방74개월(60～94개월).내고정조환자술후1년교술전관상위、시상위Cobb각현저개선(q=10.125,P＜0.05),술후1년화술후5년차이무통계학의의(q=1.031,P＞0.05);술후5년,단순감압조(D조)요추관상위Cobb각교술전정증대추세(q=3.071,P＞0.05),시상위Cobb각정감소추세(q=0.928,P＞0.05).소유환자술후1년ODI평분공능장애지수교술전현저개선(12.4±7.69비56.8±13.2,q=6.453,P＜0.05);술후5년교술후1년략유반탄,단잉현저우우술전(24.9±5.3비12.4±7.69,q=8.148,P＜0.05).결론 퇴변성요추측철수술치료적주요목적 위철저감압、중건시상면화관상면역학평형.진관성인퇴행성척주측철림상정황복잡다변,안조불동환자구체기형정황、근거개체화원칙,합리선택술식,가이유효개선환자생활질량.
Objective To investigate the clinical and radiographic outcomes for varying degrees of degenerative lumbar scoliosis using difierent surgical options with a minireal 5-year follow-up.Methods From May 1998 to November 2002.31 pailents with degenerative lumbar scoliosis underwent operations at our hospital.The mean age of 19 females and 12 males was 55.8 years old(Fange:45 to 71).All patients were divided into 4 groups:Group A,mild coronal deformity with obvious sagittal deformity,13 case;Group B,obvious coronal deformity with mild sagittal deformity;Group C,both significant coronal and sagittal deformities;Group D,both mild coronal and sagittal deformities.Posterior decompression,internal fixation and bone graft fusion were performed in Groups A,B and C.And posterior decompression was performed in Group D.All patients were followed up for at least 5 years.Patients answered the Oswestry low back pain disability questionnaire at pre-operation,and 1 year,5 year post-operation.Results Thirty patients were followed up for the whole process.According to Cobb's ansle methods,there was great postoperative imprevement for pailents with internal fixation(Groups A,B,C)while there was no significant difference for patients with posterior decompression at pre-and post-operation.After surgery,the average Oswestry Disability Index score in the patients with intemal fixation(Groups A,B,C)was significanfly lower than the preoperative score(25.8 vs 58.0;P＜0.001).However there was statistical difierence for patients with internal fixation between 1 year and 5 year postoperatively.No perioperative death or major medical complications occurred.Ten patients had adjacent segment degeneration.Conclusions The surgical aim for adults with a spinal deformity is to achieve a stable,balanced and pain-free spine.Surgical treatments should consist of decompression and fusion with segmental instrumentation to avoid instability and curb progression.Despite the complexity of adult lumbar degenerative scoliosis,it might improve the quality of life for patients by choosing an appropriate operation option on the basis of varying degrees of lumbar deformity.