退变性症状性腰椎侧凸的手术治疗.docVIP

退变性症状性腰椎侧凸的手术治疗 【摘要】 探讨后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术式治疗退变性症状性腰椎侧凸的临床效果。［方法］1999年1月~2006年4月，采用经后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术式治疗退变性症状性腰椎侧凸37例，男21例，女16例；年龄51~82岁，平均62.6岁。所有病例拍摄腰椎正侧位片及Bending片，常规备CT和MRI。根据患者下肢症状行全椎板或半椎板减压，神经根管扩大，椎间植骨融合及椎弓根螺钉间断固定。［结果］本组病例均获随访（1~6年，平均2年零7个月），术后临床症状均明显缓解，按JOA评分，手术疗效优良率91.9%，侧凸平均矫正率54.8％。随访期间无明显矫正度数及椎间隙高度丢失，术后3个月、1年复查X线片内置物无松动及断裂，植骨融合时间平均11.6周。［结论］对于退变性症状性腰椎侧凸患者：（1）采取个体化治疗，年龄不是绝对手术禁忌证，病程长短不是决定手术疗效的重要指标；（2）后路椎管减压、椎弓根螺钉间断固定、椎间植骨融合、矢状位重建术是安全有效的理想术式。 【关键词】 腰椎 退变性症状性侧凸 椎管减压术 脊柱融合术 Abstract：［Objective］To evaluate the surgical results and value of posterior lumbar decompression and intervertebral bone fusion with pedicle screw interval fixation in degenerative symptomatic lumbar scoliosis.［Method］From Jan.1999 to Apr.2006,37 cases with degenerative symptomatic lumbar scoliosis who underwent posterior lumbar decompression and intervertebral bone fusion with pedicle screw interval fixation,including 21 male and 16 female patients aged 62.6 years old averagely.All the patients were assessed by routine Xray and Bending Xray,CT and MRI were performed if necessarily.According to patients symptom,total or semilarninectomy,intervertebral bone fusion with pedicle screw interval fixation were performed.［Result］The fellowup period varied from 1 year to 6 years（average 2 years and 7 months）,clinic symptoms were effectively relieved after operation in all cases.Neurological functions were evaluated using JOA system,the clinical success rate in all 37 patients were 91.9%.The corrective rate were 54.8%.The average solid arthrodesis time was 11.6 weeks.The height of intervertebral disc and corrective rate were no loss.All patients Xray of the 3rd month and the first year didnt appear the interplantations loosen and breakage.［Conclusion］In the treatment of the elderly patients with degenerative symptomatic lumbar scoliosis,first of all,the particular principle of surgical operation should be applied,the ol