青少年脊柱侧凸合并腰椎滑脱的术式选择

Prognosis and operative treatments for patients with adolescent scoliosis associated with lumbar spondylolisthesis

中文关键词:  青少年脊柱侧凸  特发性  腰椎滑脱  手术策略，术后转归

英文关键词:Adolescent scoliosis  Idiopathic  Lumbar spondylolisthesis  Prognosis  Surgical strategy

中文摘要:

  【摘要】 目的：探讨青少年脊柱侧凸合并腰椎滑脱患者手术治疗方式的选择，观察脊柱侧凸及滑脱程度的转归。方法：对2002年5月~2011年1月收治的有完整影像学资料的9例青少年脊柱侧凸合并腰椎滑脱的患者进行回顾性分析。年龄10~18岁，平均14.4±2.7岁。功能性脊柱侧凸3例，特发性脊柱侧凸6例；发育性腰椎滑脱3例，峡部裂性腰椎滑脱6例。滑脱节段均为L5/S1，Ⅰ度滑脱4例，Ⅱ度滑脱2例，Ⅲ度滑脱2例，Ⅳ度滑脱1例。3例（1、3、4号）功能性侧凸患儿均行腰椎滑脱后路复位内固定植骨融合术。1例（2号）特发性脊柱胸腰双弯患儿侧凸Cobb角未达到手术干预标准，行单一腰椎滑脱后路复位内固定植骨融合术；2例（5、6号）无滑脱症状的特发性脊柱侧凸患儿行脊柱侧凸后路矫形内固定植骨融合术；3例（7~9号）伴腰椎滑脱症状者同时行后路滑脱复位与脊柱侧凸矫形联合手术。测量患者术前、术后、末次随访时的Cobb角及滑脱相关参数。结果：仅行单一腰椎滑脱后路复位内固定植骨融合术的4例患儿末次随访时的侧凸主弯Cobb角改善率分别为58.1%、11.5%、57.9%、36.7%，滑脱百分比改善率分别为61.3%、76.9%、59.7%、27.3%；2例仅行脊柱侧凸后路矫形内固定植骨融合术患儿的侧凸主弯Cobb角改善率分别为81.8%及68.6%，滑脱百分比改善率分别为71.8%及25.0%；3例同时行腰椎滑脱后路复位和脊柱侧凸矫形内固定植骨融合术患儿末次随访时Cobb角改善率分别为86.2%、75.6%、72.9%，滑脱百分比改善率分别为31.8%、50.0%、67.7%。7例患儿术前有不同程度的腰痛症状，1~4号患儿ODI评分为26.0（21.0~31.0）分，7~9号为23.0（15.0~29.0）分，末次随访时分别为7.0（5.0~10.0）分和6.0（5.0~8.0）分。9例患儿在术后及随访过程中均未出现并发症。结论：对青少年脊柱侧凸合并腰椎滑脱患儿应根据侧凸类型及腰椎滑脱程度选择手术方式，侧凸Cobb角大于40°伴腰椎滑脱所致腰痛症状时，应同时行脊柱侧凸矫形术和腰椎滑脱复位术；若仅满足腰椎滑脱复位内固定或者仅满足脊柱侧凸矫形的手术干预要求，可考虑行单一后路行腰椎滑脱复位内固定术或单一后路脊柱侧凸矫形手术。

英文摘要:

  【Abstract】 Objectives: To investigate the prognosis and operative treatments for patients with adolescent scoliosis associated with lumbar spondylolisthesis. Methods: A total of 9 adolescent scoliosis associated with lumbar spondylolisthesis cases from May 2002 to January 2011 was included in this study. The average age of 9 patients was 14.4±2.7 ys(range, 10-18 ys). Long-cassette standing posterior-anterior and lateral radiographs of the spine at pre-operation, post-operation and last follow-up were obtained from these patients in the fist-on-clavicle position. The 9 patients included 3 functional and 6 idiopathic scoliosis, 3 developmental and 6 isthmic spondylolisthesis. All patients received different surgical procedures and were numbered as 1-9. All of their listhesis levels were L5/S1. According to Meyerding system, there were 4 cases at grade Ⅰ, 2 at grade Ⅱ, 2 at grade Ⅲ, 1 at grade Ⅳ. 3 patients with functional scoliosis received only slippage reduction and posterior lumbar interbody fusion. 2 patients without low back pain were treated with only scoliosis correction. And the other 3 symptomatic patients received surgical reduction combined with correction of scoliosis. Measurement parameters were as followings: Cobb angle, slip angle, slip distance and slip percentage. The patient′s low back pain was assessed by Oswestry disability index(ODI). Results: The average rate of improvement of Cobb angle on different surgical procedures was 41.4%(11.5%-58.1%), 75.2%(68.6%-81.8%) and 78.2%(72.9%-86.2%) respectively, meanwhile the slip percentage was 56.3%(27.3%-76.9%), 48.4%(25.0%-71.8%) and 49.8%(31.8%-67.7%) respectively. 7 patients presented with low back pain. The ODI scores declined from 26.0（21.0-31.0） and 23.0（15.0-29.0） to 7.0（5.0-10.0） and 6.0（5.0-8.0） after different interventions. No postoperative complications were found in our series. Conclusions: The severe scoliosis should be considered idiopathic and should be treated differently apart from spondylolisthesis when spondylolisthesis is asymptomatic. If spondylolisthesis is symptomatic, scoliosis should be treated together with spondylolisthesis according to the curve magnitude.