中国骨与关节杂志
中國骨與關節雜誌
중국골여관절잡지
Chinese Journal of Bone and Joint
2014年
12期
931-934
,共4页
陈铭%范海泉%江洋%黄海讯%俞阳
陳銘%範海泉%江洋%黃海訊%俞暘
진명%범해천%강양%황해신%유양
椎管狭窄%脊柱侧凸%脊柱融合术%腰椎%脊柱
椎管狹窄%脊柱側凸%脊柱融閤術%腰椎%脊柱
추관협착%척주측철%척주융합술%요추%척주
Spinal stenosis%Scoliosis%Spinal fusion%Lumbar vertebrae%Spine
目的：观察选择性椎管减压及融合术治疗退变性腰椎侧凸合并椎管狭窄(degenerativelumbarscoliosiswithstenosis，DLSS)患者的临床疗效。方法2007年2月至2011年1月，我院经后路治疗DLSS患者28例。男11例，女17例；年龄54～73岁，平均67.3岁。病程4～8年。术前Cobb’s角15°～49°，平均31°；腰椎前凸角(T12～S1)-30.6°～3.3°，平均-10.5°。对Cobb’s角＜20°的5例行选择性椎管或神经根管减压，经后路椎体间融合，短节段椎弓根钉棒系统固定；对Cobb’s角＞20°的23例行椎管减压，长节段固定侧凸矫正，后路椎体间融合及后外侧自体骨植骨融合。采用视觉模拟评分(visualanaloguescale，VAS)、日本骨科协会(Japaneseorthopedicassociation，JOA)评分评估临床疗效，应用SF-36调查问卷对患者治疗前和末次随访时生活质量变化情况进行评价。结果28例行减压手术节段113个，平均减压4.0个节段；共融合90个节段，平均融合3.2个节段。术后随访24～70个月，平均32个月，平均手术时间为(3.5±0.5)h，出血(600±30)ml，末次随访时腰痛及腿痛VAS评分较治疗前明显降低(P＜0.05)，侧凸由术前平均31°矫正至术后平均15.2°，改善率平均为51.0%。腰椎前凸角矫正为5.4°～28.2°，平均18.4°。腰椎前凸角及侧凸Cobb’s角均明显改善(P＜0.05)。术前JOA评分平均13.6分，末次随访时平均27.5分(P＜0.05)。所有患者生活质量明显提高，SF-36调查问卷表中的8个维度分值均较术前明显提高(P＜0.05)。结论 DLSS的治疗应个体化地选择治疗方案。手术治疗以减压为主、矫形为辅，应准确判断责任节段，临床疗效满意，患者的生活质量明显提高。
目的：觀察選擇性椎管減壓及融閤術治療退變性腰椎側凸閤併椎管狹窄(degenerativelumbarscoliosiswithstenosis，DLSS)患者的臨床療效。方法2007年2月至2011年1月，我院經後路治療DLSS患者28例。男11例，女17例；年齡54～73歲，平均67.3歲。病程4～8年。術前Cobb’s角15°～49°，平均31°；腰椎前凸角(T12～S1)-30.6°～3.3°，平均-10.5°。對Cobb’s角＜20°的5例行選擇性椎管或神經根管減壓，經後路椎體間融閤，短節段椎弓根釘棒繫統固定；對Cobb’s角＞20°的23例行椎管減壓，長節段固定側凸矯正，後路椎體間融閤及後外側自體骨植骨融閤。採用視覺模擬評分(visualanaloguescale，VAS)、日本骨科協會(Japaneseorthopedicassociation，JOA)評分評估臨床療效，應用SF-36調查問捲對患者治療前和末次隨訪時生活質量變化情況進行評價。結果28例行減壓手術節段113箇，平均減壓4.0箇節段；共融閤90箇節段，平均融閤3.2箇節段。術後隨訪24～70箇月，平均32箇月，平均手術時間為(3.5±0.5)h，齣血(600±30)ml，末次隨訪時腰痛及腿痛VAS評分較治療前明顯降低(P＜0.05)，側凸由術前平均31°矯正至術後平均15.2°，改善率平均為51.0%。腰椎前凸角矯正為5.4°～28.2°，平均18.4°。腰椎前凸角及側凸Cobb’s角均明顯改善(P＜0.05)。術前JOA評分平均13.6分，末次隨訪時平均27.5分(P＜0.05)。所有患者生活質量明顯提高，SF-36調查問捲錶中的8箇維度分值均較術前明顯提高(P＜0.05)。結論 DLSS的治療應箇體化地選擇治療方案。手術治療以減壓為主、矯形為輔，應準確判斷責任節段，臨床療效滿意，患者的生活質量明顯提高。
목적：관찰선택성추관감압급융합술치료퇴변성요추측철합병추관협착(degenerativelumbarscoliosiswithstenosis，DLSS)환자적림상료효。방법2007년2월지2011년1월，아원경후로치료DLSS환자28례。남11례，녀17례；년령54～73세，평균67.3세。병정4～8년。술전Cobb’s각15°～49°，평균31°；요추전철각(T12～S1)-30.6°～3.3°，평균-10.5°。대Cobb’s각＜20°적5례행선택성추관혹신경근관감압，경후로추체간융합，단절단추궁근정봉계통고정；대Cobb’s각＞20°적23례행추관감압，장절단고정측철교정，후로추체간융합급후외측자체골식골융합。채용시각모의평분(visualanaloguescale，VAS)、일본골과협회(Japaneseorthopedicassociation，JOA)평분평고림상료효，응용SF-36조사문권대환자치료전화말차수방시생활질량변화정황진행평개。결과28례행감압수술절단113개，평균감압4.0개절단；공융합90개절단，평균융합3.2개절단。술후수방24～70개월，평균32개월，평균수술시간위(3.5±0.5)h，출혈(600±30)ml，말차수방시요통급퇴통VAS평분교치료전명현강저(P＜0.05)，측철유술전평균31°교정지술후평균15.2°，개선솔평균위51.0%。요추전철각교정위5.4°～28.2°，평균18.4°。요추전철각급측철Cobb’s각균명현개선(P＜0.05)。술전JOA평분평균13.6분，말차수방시평균27.5분(P＜0.05)。소유환자생활질량명현제고，SF-36조사문권표중적8개유도분치균교술전명현제고(P＜0.05)。결론 DLSS적치료응개체화지선택치료방안。수술치료이감압위주、교형위보，응준학판단책임절단，림상료효만의，환자적생활질량명현제고。
Objective To investigate the therapeutic outcomes of selective decompression and fusion for degenerative lumbar scoliosis with stenosis ( DLSS ). Methods From February 2007 to January 2011, 28 patients with DLSS underwent posterior surgery. There were 11 males and 17 females, whose average age was 67.3 years old ( range:54-73 years ). The course of disease lasted from 4 to 8 years. Preoperatively the mean Cobb’s angle was 31° ( range:15°-49° ), and the mean lordosis angle ( T12-S1 ) was-10.5° ( range:-30.6°-3.3° ). Selective spinal canal or nerve root canal decompression was performed on 5 patients with the Cobb’s angle<20°, who then received posterior lumbar interbody fusion and short-segment pedicle instrumentation. Twenty-three patients with the Cobb’s angle>20° underwent spinal canal decompression, long-segment pedicle instrumentation, scoliosis correction, posterior lumbar interbody fusion and posterolateral autograft bone fusion. The clinical outcomes were evaluated by Visual Analogue Scale ( VAS ) scores and Japanese Orthopedic Association ( JOA ) scores. The Medical Outcomes Study 36-item short-form health survey ( SF-36 ) was used to assess the patients’ quality of life before the operation and in the latest follow-up. Results Decompression was performed on 113 segments and fusion on 90 segments in 28 patients. The average number of decompressed segments was 4.0 and the average number of fused segments was 3.2. The mean follow-up period was 32 months ( range:24-70 months ). The mean surgery time was ( 3.5±0.5 ) h, and the mean blood loss was ( 600±30 ) ml. In the latest follow-up, the VAS scores of low back and leg pain were obviously decreased when compared with the preoperative VAS scores ( P<0.05 ). The preoperative Cobb’s angle was 31° on average, which was corrected to 15.2° postoperatively, and the mean correction rate was 51.0%. The lordosis angle was corrected to 18.4° on average ( range:5.4°-28.2° ). Both the lordosis angle and Cobb’s angle were obviously improved ( P<0.05 ). The average JOA score was 13.6 points preoperatively and 27.5 points in the latest follow-up ( P<0.05 ). All the patients’ quality of life was significantly improved. The scores of all the 8 SF-36 domains were significantly improved postoperatively ( P<0.05 ). Conclusions An individualized surgical therapy should be chosen for DLSS. Decompression is given priority and fusion is complementary, when the surgical plan is designed. The responsible segment should be judged accurately. The clinical outcomes are satisfactory, and the patients’ quality of life is signiifcantly improved.
