CAJ | 학술논문

目的评估外科手术治疗退行性腰椎侧凸（DLS）的临床疗效和手术并发症。方法2003年1月至2013年1月广州军区广州总医院骨科医院采用选择性椎管减压＋椎弓根钉内固定＋椎体间融合器融合矫形术治疗62例DLS患者。观察术中出血量及术后下肢疼痛改善和肌力恢复情况，测量手术前后腰椎侧凸、腰椎生理前凸Cobb角和椎间植骨融合情况，记录手术前后视觉模拟量表（VAS）评分、体征以及围术期及远期并发症。结果61例患者手术过程顺利，1例因术中血压过低未完成一期手术，3 d后行二次手术。术中出血量平均920 mL（530～2800 mL）。围手术期并发症7例（11%），其中脑梗塞2例、脑脊液漏2例、一侧下肢肌力下降3例。术后41例患者获得随访，随访率66%；随访时间0.5～10.0年，平均随访时间5.6年。随访期间远期并发症6例（15%，6/41），其中3例患者出现螺钉松动并行翻修手术，3例患者融合固定的上个节段出现椎体压缩性骨折，予椎体成形术治疗。VAS评分由术前的平均7.4分（6.1～8.5分）降低至术后的2.8分（1.6～4.3分），术前、术后腰椎侧凸及腰椎生理前凸Cobb角分别为30.5°（20°～40°）、8.6°（3°～25°）和5.6°（-8°～13°）、31.6°（25°～46°）。随访期间X线片示融合器融合节段均已愈合，椎间高度无丢失，融合器无塌陷或移位。结论选择性椎管减压+椎弓根钉内固定+椎体间融合器融合矫形术治疗DLS能有效解除患者的腰腿痛症状，重建腰椎生理前凸，纠正腰椎侧凸；但手术并发症发生率较高。
목적평고외과수술치료퇴행성요추측철（DLS）적림상료효화수술병발증。방법2003년1월지2013년1월엄주군구엄주총의원골과의원채용선택성추관감압＋추궁근정내고정＋추체간융합기융합교형술치료62례DLS환자。관찰술중출혈량급술후하지동통개선화기력회복정황，측량수술전후요추측철、요추생리전철Cobb각화추간식골융합정황，기록수술전후시각모의량표（VAS）평분、체정이급위술기급원기병발증。결과61례환자수술과정순리，1례인술중혈압과저미완성일기수술，3 d후행이차수술。술중출혈량평균920 mL（530～2800 mL）。위수술기병발증7례（11%），기중뇌경새2례、뇌척액루2례、일측하지기력하강3례。술후41례환자획득수방，수방솔66%；수방시간0.5～10.0년，평균수방시간5.6년。수방기간원기병발증6례（15%，6/41），기중3례환자출현라정송동병행번수수술，3례환자융합고정적상개절단출현추체압축성골절，여추체성형술치료。VAS평분유술전적평균7.4분（6.1～8.5분）강저지술후적2.8분（1.6～4.3분），술전、술후요추측철급요추생리전철Cobb각분별위30.5°（20°～40°）、8.6°（3°～25°）화5.6°（-8°～13°）、31.6°（25°～46°）。수방기간X선편시융합기융합절단균이유합，추간고도무주실，융합기무탑함혹이위。결론선택성추관감압+추궁근정내고정+추체간융합기융합교형술치료DLS능유효해제환자적요퇴통증상，중건요추생리전철，규정요추측철；단수술병발증발생솔교고。
Objective To evaluate the clinical efficacy and the complications in the surgical treatment for patients with degenerative lumbar scoliosis (DLS). Methods A total of 62 DLS patients were treated using procedures of selective spinal canal decompression + pedicle screw fixation + Cage interbody fusion and correction in Guangzhou General Hospital of Guangzhou Military Command during January 2003 to January 2013. Estimate blood loss, postoperative pain relief in lower extremity and recovery of muscle strength were observed, lumbar scoliosis, lordosis and interbody fusion were examined, and visual analogue scale (VAS) scores, signs and complications were recorded. Results In 62 patients, 61 patients completed surgery smoothly, while 1 patient underwent reoperation 3 d after the first surgery due to intraoperative hypopiesia. Estimate blood loss was 530-2 800 mL with the average of 920 mL. Perioperative complications occurred in 7 cases (11%), including brain infarction in 2 cases, cerebrospinal fluid leakage in 2 cases, muscle strength decreased in unilateral lower extremity in 3 cases. Forty-one patients were followed up from 0.5 to 10.0 years (average, 5.6 years). During the follow-up, 6 patients had long-term complications (15%, 6/41), including screw loosening in 3 cases who performed the following revision operation, and vertebral compression fractures in 3 patients who underwent the following vertebroplasty. VAS scores decreased from the average of 7.4 (6.1-8.5) at preoperation to the average of 2.8(1.6-4.3) at postopoeration. Preoperative and postoperative lumbar scoliotic, lordotic Cobb angles were 30.5° (20°-40°) and 8.6° (3°-25°), 5.6° (-8°-13°) and 31.6° (25°-46°) respectively. X-ray showed good fusion in all cases. There was no intervetebral height loss, also no Cage collapse or dislocation occurred. Conclusions Procedures of selective spinal canal decompression + pedicle screw fixation + lumbar interbody fusion and correction can relieve back and leg pain effectively, rebuild and maintain the lumbar lodorsis, and correct scoliosis, but the incidence of surgical complications is relative high.