选择性减压融合治疗伴退行性侧凸的腰椎管狭窄症

Selected decompression and fusion for lumbar canal stenosis associated with degenerative scoliosis

中文关键词:  腰椎管狭窄症  退行性侧凸  手术  疗效

英文关键词:Lumbar stenosis  Degenerative scoliosis  Operation  Ｃlinical efficacy

中文摘要:

  【摘要】 目的：观察选择性椎管减压及融合术治疗伴退行性侧凸的腰椎管狭窄症患者的临床疗效。方法：33例退行性腰椎管狭窄伴侧凸患者，术前根据患者症状、体征及影像学检查结果确定减压节段及选择融合节段，对引起临床症状的节段进行减压，针对术前即有不稳或减压术后可能出现不稳的节段进行融合，采用JOA评分、ODI量表评估临床疗效，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：33例患者共减压62个节段，平均减压1.9个节段；共融合52个节段，平均融合1.6个节段。术后随访12～84个月，平均38个月，所有患者疼痛明显缓解，生活质量明显提高。术前JOA评分平均15.8分，末次随访时平均26.4分（P<0.05）。术前ODI评分平均66.5分，末次随访时平均37.6分（P<0.05）。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）。侧凸由术前平均19.3°矫正至术后平均12.7°，改善率平均为34.2％。结论：在仔细分析病情的基础上，选择个体化手术方案治疗伴退行性侧凸的腰椎管狭窄症可取得满意的临床疗效，提高患者的生活质量。

英文摘要:

  【Abstract】　Objective：To investigate therapeutic effects of selective decompression and fusion for lumbar cannal stenosis associated with degenerative scoliosis.Method：33 cases of lumbar stenosis with degenerative scoliosis were reviewed retrospectively.The involved segements were determined by symptoms，clinical features and radiographic documents.We carried out decompression of the nerve roots on the segments inducing the clinical symptoms and selected fusion on the segments with preoperative instability or probably iatrogenic postoperative unstable.The clinical outcomes were evaluated by Japanese Orthopedic Association（JOA） score and Oswestry Disability Index（ODI）.The SF-36 questionary was used to evaluated the patients′ life quality before and after operation as well.Result：Decompression was done on 62 segments and fusion on 52 segments in 33 patients. The average number of decompressed level was 1.9 and fusion was 1.6.The mean follow-up period was 38 months（range，12~84 months）.The average of JOA score and ODI was 15.8 and 66.5 points at the initial examination and 26.4 and 37.6 points at the final follow-up respectively（P<0.05）.All domains of SF-36 score were significantly improved postoperatively（P<0.05）.The average Cobb′s angle was preoperative 19.3 degrees and postoperative 12.7 degrees with a mean correction rate of 34.2%.Conclusion：This investigation suggests that the selected decompression and fusion for lumbar cannal stenosis with degenerative scoliosis can provide a good clinical outcome when the surgical plan is designed individually based on the careful evaluation of each patient′s features.