CAJ | 학술논문

目的探讨微创技术联合应用治疗成人腰椎侧凸的临床疗效。方法回顾性分析2008年8月至2011年5月联合应用多种脊柱外科微创技术治疗的18例成人腰椎侧凸患者的临床资料，记录手术时间、术中出血量和并发症发生情况，比较手术前后冠状位及矢状位Cobb角、视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分的差异。结果18例患者均获随访，随访时间3～35个月（平均13.4个月）。手术时间107～205 min，平均手术时间135 min；出血量150～1300 mL，平均出血量238 mL。术中未发生大血管、输尿管、肠管损伤等并发症；7例患者术后出现屈髋功能障碍，其中5例于术后1个月内恢复、2例于术后3个月内恢复；4例出现大腿前侧及腹股沟区浅感觉减退，术后1个月均明显好转。末次随访时冠状位Cobb角由术前的39.5°±5.6°矫正至14.3°±6.3°，改善率为63.8%；矢状位Cobb角由术前的21.6°±3.1°增加到26.3°±2.1°，改善率为21.8%；VAS评分由术前的（8.3±1.3）分减小到（3.2±1.0）分，改善率为61.4%；ODI评分由术前的（44.6±2.2）分降至（11.8±5.2）分，改善率为73.5%。上述指标手术前后比较，差异均有统计学意义（P＜0.05）。结论微创脊柱外科技术联合应用治疗成人腰椎侧凸矫形效果良好、固定稳固、创伤小、安全性高，值得推广。
목적탐토미창기술연합응용치료성인요추측철적림상료효。방법회고성분석2008년8월지2011년5월연합응용다충척주외과미창기술치료적18례성인요추측철환자적림상자료，기록수술시간、술중출혈량화병발증발생정황，비교수술전후관상위급시상위Cobb각、시각모의량표（VAS）평분화Oswestry공능장애지수（ODI）평분적차이。결과18례환자균획수방，수방시간3～35개월（평균13.4개월）。수술시간107～205 min，평균수술시간135 min；출혈량150～1300 mL，평균출혈량238 mL。술중미발생대혈관、수뇨관、장관손상등병발증；7례환자술후출현굴관공능장애，기중5례우술후1개월내회복、2례우술후3개월내회복；4례출현대퇴전측급복고구구천감각감퇴，술후1개월균명현호전。말차수방시관상위Cobb각유술전적39.5°±5.6°교정지14.3°±6.3°，개선솔위63.8%；시상위Cobb각유술전적21.6°±3.1°증가도26.3°±2.1°，개선솔위21.8%；VAS평분유술전적（8.3±1.3）분감소도（3.2±1.0）분，개선솔위61.4%；ODI평분유술전적（44.6±2.2）분강지（11.8±5.2）분，개선솔위73.5%。상술지표수술전후비교，차이균유통계학의의（P＜0.05）。결론미창척주외과기술연합응용치료성인요추측철교형효과량호、고정은고、창상소、안전성고，치득추엄。
Objective To explore the clinical efficacy of combined minimally invasive techniques for adult lumbar scoliosis. Methods From August 2008 to May 2011, 18 patients with adult lumbar scoliosis were treated by multiple minimally invasive spine surgical techniques in General Hospital of PLA. Operative time, estimate blood loss and the complications were recorded, coronal and sagittal Cobb angles, visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores were compared respectively between preoperation and the last follow-up. Results All patients were followed up from 3 to 35 months, with an average of 13.4 months. Operative time was from 107 to 205 min (average, 135 min); Estimate blood loss was from 150 to 1 300 mL, with the average of 238 mL. No major vascular, ureter, bowel and other injuries occurred. Postoperative hip flexor dysfunction had happened in 7 cases, of which 5 cases recovered in 1 month and 2 cases in 3 months;The superficial sensory loss in front thigh and groin area occurred in 4 cases and were improved within a month. At the last follow-up, coronal Cobb angle was corrected from 39.5° ± 5.6° to 14.3° ± 6.3° , the improvement rate (IR) was 63.8%; Sagittal Cobb angle was improved from 21.6° ± 3.1° to 26.3° ± 2.1° , IR was 21.8%;Postoperative VAS score was lower than preoperative one (from 8.3 ± 1.3 to 3.2 ± 1.0), and IR was 61.4%; ODI score decreased from 44.6 ± 2.2 to 11.8 ± 5.2, with IR of 73.5%. There were statistical differences of the above parameters between preoperation and the final follow-up (P <0.05). Conclusion Combined minimally invasive spine surgical techniques for adult lumbar scoliosis is worthy of promoting due to good orthopedic effects, solid fixation, less invasive injury, and safety.