CAJ | 학술논문

目的探讨老年人退行性脊柱侧弯(DS)长节段矫形固定融合术的手术疗效. 方法回顾性分析2011年1月至2013年12月在北京医院骨科就诊的27例DS患者的临床资料,患者均为退行性脊柱侧凸,伴有腰椎管狭窄、腰椎滑脱、腰椎冠状面滑移、椎体旋转畸形和脊柱后凸畸形,记录手术减压截骨固定节段、失血量、手术时间等情况,比较术前和术后末次随访时患者侧凸角度(Cobb角)、腰椎前凸角度、顶椎旋转程度(Nash-Moe椎体旋转分级)、顶椎偏移距离、疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分的差异. 结果 27例患者中,根据病情采用选择性减压1～5个节段和固定融合5～10个节段,部分患者结合SP截骨,全部27例均行椎板后方和横突间植骨融合术,其中25例患者还加用椎间融合.术后随访至少1年,末次随访脊柱侧凸冠状面Cobb角、腰椎前凸角、顶椎偏移距离以及VAS、ODI评分分别为(11±6)°、(32±10)°、(16.3±8.2)mm、(3.3±1.6)分、(18±14)分,均优于术前(35±6)°、(17±9)°、(32.2±9.8)mm、(7.3±2.1)分、(33±14)分,差异有统计学意义(t=2.469、2.313、2.331、2.362、2.395,P=0.021、0.030、0.029、0.026、0.023).手术满意度调查结果显示,优19例、良5例、可3例.术后9例出现并发症,其中2例发生固定上端椎体内螺钉松动,2例有相邻节段退变,肺部和泌尿系感染各1例,硬脊膜漏2例,硬膜外血肿1例,无严重并发症和死亡病例. 结论在严格掌握适应证的条件下,对病情严重的老年DS患者行有限减压、截骨矫形和长节段固定融合可获得良好疗效.
목적 탐토노년인퇴행성척주측만(DS)장절단교형고정융합술적수술료효. 방법 회고성분석2011년1월지2013년12월재북경의원골과취진적27례DS환자적림상자료,환자균위퇴행성척주측철,반유요추관협착、요추활탈、요추관상면활이、추체선전기형화척주후철기형,기록수술감압절골고정절단、실혈량、수술시간등정황,비교술전화술후말차수방시환자측철각도(Cobb각)、요추전철각도、정추선전정도(Nash-Moe추체선전분급)、정추편이거리、동통시각모의량표(VAS)평분화Oswestry공능장애지수(ODI)평분적차이. 결과 27례환자중,근거병정채용선택성감압1～5개절단화고정융합5～10개절단,부분환자결합SP절골,전부27례균행추판후방화횡돌간식골융합술,기중25례환자환가용추간융합.술후수방지소1년,말차수방척주측철관상면Cobb각、요추전철각、정추편이거리이급VAS、ODI평분분별위(11±6)°、(32±10)°、(16.3±8.2)mm、(3.3±1.6)분、(18±14)분,균우우술전(35±6)°、(17±9)°、(32.2±9.8)mm、(7.3±2.1)분、(33±14)분,차이유통계학의의(t=2.469、2.313、2.331、2.362、2.395,P=0.021、0.030、0.029、0.026、0.023).수술만의도조사결과현시,우19례、량5례、가3례.술후9례출현병발증,기중2례발생고정상단추체내라정송동,2례유상린절단퇴변,폐부화비뇨계감염각1례,경척막루2례,경막외혈종1례,무엄중병발증화사망병례. 결론 재엄격장악괄응증적조건하,대병정엄중적노년DS환자행유한감압、절골교형화장절단고정융합가획득량호료효.
Objective To investigate the surgical curative effect of long-segment fixation and fusion on the degenerative scoliosis (DS) in the elderly.Methods The clinical data of 27 patients with DS undergoing surgical treatment from January 2011 to December 2013 in our department in Beijing Hospital were retrospectively analyzed.All patients suffered from degenerative scoliosis accompanied with lumbar canal stenosis, lumbar spondylolisthesis, lumbar vertebrae lateral slip in coronal surface, spinal vertebral rotation deformity and kyphosis.The decompression osteotomy and fixed segment, blood loss volume and operation time were recorded.The differences in scoliosis angle (Cobb angle), lumbar lordotic angle, top vertebral rotation degree (Nash-Moe vertebral rotation grade), apical vertebral offset distance, visual analogue scale (VAS) score and Oswestry disability index (ODI) score were compared between pretreatment versus the last follow-up.Results The selective 1-5 segment decompression and 5-10 segment fusion were selected in a total of 27 patients.Some patients were treated with Smith-Petersen osteotomy (SPO).All of 27 cases were treated with a lamina and inter-transverse fusion, among which 25 cases took inter-vertebral fusion additionally.The time of postoperative follow-up was more than 1 year.The Cobb angle, lumbar lordotic angle, apical vertebral offset distance, VAS and ODI scores were improved after treatment as compared with pretreatment [(11 6) vs.35 6 , (32±10) vs.(17±9) , (16.3±8.2) mm vs.(32.2±9.8) mm, (3.3±1.6) vs.(7.3±2.1), (18±14) vs.(33±14), t=2.469, 2.313, 2.331, 2.362, 2.395, P=0.021, 0.030, 0.029, 0.026, 0.023 respectively].The satisfaction survey result was excellent in 19cases, good in 5 cases, fair in 3 cases.Complications were found in 9 patients, among whom 2 cases had screw loosening in the internal fixation, 2 cases had adjacent segment degeneration, 1 case had pulmonary infection, 1 case had urinary tract infection, 2 eases had spinal fluid leakage, 1 case had epidural hematoma.No serious complications and deaths were observed.Conclusions Under strictly controlling the therapeutic indications, the limited decompression and long-segmental fixation and fusion have good therapeutic efficacy on degenerative scoliosis in elderly patients.