CAJ | 학술논문

目的：评估后路减压联合椎间融合治疗腰椎退变性侧凸的临床疗效，探讨腰椎退变性侧凸的手术策略。方法回顾性分析手术治疗腰椎退变性侧凸患者98例，男35例，女63例；平均年龄（56±9）岁；平均侧凸Cobb角为（26±9）°；平均腰椎前凸为（19±11）°。采用后正中入路，行责任节段减压联合椎间融合内固定治疗。采用JOA29分标准进行临床疗效评定以及Cobb角和腰椎前凸角变化来评价手术疗效。结果平均随访时间（3.7±2.4）年。术前JOA评分为（10±2）分，提高到末次随访时的（26±3）分；优良率为89.7%。无患者术后症状加重，所有患者均感觉较术前症状明显减轻。平均椎间达骨性融合时间为（5.7±1.4）个月。末次随访时X线片示平均腰椎侧凸Cobb角为（6±2）°，平均矫正度数为（17±4）°，矫正率为59.2%；平均腰椎前凸矫正度数为（12±3）°。无内固定断裂和松动；钛合金cage轻度后侧移位2例，无不适症状，未做处理。结论对于有临床症状的退变性腰椎侧凸，且保守治疗无效的患者，采用后路减压联合椎间融合治疗可以取得满意的临床疗效。但责任节段的确定、减压充分和恢复腰椎稳定性是长期疗效的保证。
목적：평고후로감압연합추간융합치료요추퇴변성측철적림상료효，탐토요추퇴변성측철적수술책략。방법회고성분석수술치료요추퇴변성측철환자98례，남35례，녀63례；평균년령（56±9）세；평균측철Cobb각위（26±9）°；평균요추전철위（19±11）°。채용후정중입로，행책임절단감압연합추간융합내고정치료。채용JOA29분표준진행림상료효평정이급Cobb각화요추전철각변화래평개수술료효。결과평균수방시간（3.7±2.4）년。술전JOA평분위（10±2）분，제고도말차수방시적（26±3）분；우량솔위89.7%。무환자술후증상가중，소유환자균감각교술전증상명현감경。평균추간체골성융합시간위（5.7±1.4）개월。말차수방시X선편시평균요추측철Cobb각위（6±2）°，평균교정도수위（17±4）°，교정솔위59.2%；평균요추전철교정도수위（12±3）°。무내고정단렬화송동；태합금cage경도후측이위2례，무불괄증상，미주처리。결론대우유림상증상적퇴변성요추측철，차보수치료무효적환자，채용후로감압연합추간융합치료가이취득만의적림상료효。단책임절단적학정、감압충분화회복요추은정성시장기료효적보증。
Objective To assess the clinical outcomes of posterior decompression and lumbar interbody fusion with internal fixation treatment for degenerative lumbar scoliosis (DLS). Methods Ninety-eight patients underwent surgery for DLS were retrospectively reviewed in this study. The mean age of the patients(male 35 and femail 63) was (56±9) years. The mean Cobb angle of curves was (26±9)° and the mean scoliosis Cobb angle of lumbar was (19±11)° in patients before surgery. A posterior medial incision was made for spinal exposure. According to the preoperative plan, patients were operated with posterior de-compression and lumbar interbody fusion with internal fixation. The clinical outcomes were assessed by the JOA scores.The preoperative and postoperative Cobb angle was recorded. Results The mean follow-up time was (3.7±2.4) years. The mean JOA scores were improved from (10±2) points preoperatively to (26±3) points at the last follow-up. The excellent or good outcome rates were 89.7%for patients with surgery. The average interbody fusion time was (5.7±1.4) months. The mean postoperative Cobb angle was (6±2)° at the last follow-up, and the mean Cobb angle correction was (17±4)°, with the correction rate of 59.2%. The mean lumbar lordosis angle was (12±3)°. There was no failure in internal fixation. Conclusion The posterior decompression and lumbar interbody fusion with internal fixation appears to be a reasonable option for degenerative lumbar scoliosis.