CAJ | 학술논문

目的探讨选择性减压长节段固定融合治疗退变性腰椎侧凸（DLS）的手术疗效。方法回顾性分析2004年1月至2007年6月首都医科大学附属北京朝阳医院采用选择性减压、长节段固定融合手术治疗的19例DLS患者的临床资料。记录手术减压固定节段、失血量等相关情况，比较术前和末次随访时患者侧凸角度、腰椎前凸角度、视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分的差异。结果手术减压1～4个节段，固定融合5～9个节段，椎间融合15例患者，共24个节段。术前和末次随访时患者Cobb角、腰椎前凸角度、冠状面失平衡、矢状面失平衡、VAS评分、ODI评分比较，差异有统计学意义（P＜0.05）。术后至少1年手术满意度调查结果显示，12例患者表示愿意再次接受手术治疗。术后9例出现并发症，其中硬脊膜漏2例，无其他严重并发症和死亡病例，无一例发生内固定失败。结论对于伴有脊柱冠状面和矢状面失平衡的DLS患者，有限减压和长节段固定融合可获得良好疗效。
목적탐토선택성감압장절단고정융합치료퇴변성요추측철（DLS）적수술료효。방법회고성분석2004년1월지2007년6월수도의과대학부속북경조양의원채용선택성감압、장절단고정융합수술치료적19례DLS환자적림상자료。기록수술감압고정절단、실혈량등상관정황，비교술전화말차수방시환자측철각도、요추전철각도、시각모의량표（VAS）평분화Oswestry공능장애지수（ODI）평분적차이。결과수술감압1～4개절단，고정융합5～9개절단，추간융합15례환자，공24개절단。술전화말차수방시환자Cobb각、요추전철각도、관상면실평형、시상면실평형、VAS평분、ODI평분비교，차이유통계학의의（P＜0.05）。술후지소1년수술만의도조사결과현시，12례환자표시원의재차접수수술치료。술후9례출현병발증，기중경척막루2례，무기타엄중병발증화사망병례，무일례발생내고정실패。결론대우반유척주관상면화시상면실평형적DLS환자，유한감압화장절단고정융합가획득량호료효。
Objective To analyze the surgical effect of selective decompression and long segmental fusion for degenerative lumbar scoliosis (DLS). Methods Nineteen DLS patients without prior spinal diseases were performed selective decompression and long segmental fusion from January 2004 to June 2007 in Chaoyang Hospital affiliated to Capital Medical University. Surgical segments as well as estimate blood loss were recorded, the differences of Cobb angles,lumbar lordotic angles, visual analogue scale (VAS) score and Oswestry disability index (ODI) between preoperation and the last follow-up were compared. Results Decompression involved 1-4 segments, fusion levels ranged from 5-9 vertebral bodies, and interbody fusion was performed in 15 patients and 24 levels were fused. The differences of Cobb angles, lumbar lordotic angles,coronal/sagittal imbalance, VAS scores and ODI scores had statistical significance between preoperation and the final follow-up(P <0.05). Results of degree of satisfaction at more than 1 year follow-up showed that 12 patients would like to accept the same surgical treatment again. Nine patients had postoperative complications, including 2 cases of dural leakage. No death or other major complications occurred, and no internal fixator failures had happened at the final follow-up. Conlusions Selective decompression and long segmental fusion is an effective method for DLS patients with coronal or sagittal imbalance.