| 杨诚,高春华,彭宝淦.腰椎退变性侧凸的外科治疗策略[J].脊柱外科杂志,2012,10(6):330-333. |
腰椎退变性侧凸的外科治疗策略  点此下载全文 (Fulltext) |
| 杨诚 高春华 彭宝淦 |
| 100039 北京, 武警总医院脊柱外科;100039 北京, 武警总医院脊柱外科;100039 北京, 武警总医院脊柱外科 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2012.06.003 |
| 摘要点击次数: 1463 |
| 全文下载次数: 844 |
| 摘要： |
| 目的 探讨腰椎退变性侧凸的手术治疗策略。方法 对2006~2011年接受手术治疗的36例腰椎退变性侧凸患者的临床资料进行回顾性分析。依据患者特点制定个性化治疗方案，有20例行全椎板切除减压矫形椎弓根螺钉内固定术，有16例行椎板切除椎弓根螺钉内固定并椎间Cage植骨融合矫形固定术。术前、术后均行影像学检查，记录患者减压方式、范围及功能改善情况。结果 患者术后腰腿痛症状及间歇性跛行较术前有明显好转，内固定物融合良好，随访过程中有2例分别在术后4个月和11个月发生L5两侧螺钉松动，未给与特殊处置，继续随访观察未见有松动加重迹象。有3例患者术后L5/S1节段椎间盘退变较术加重，其中2例腰痛症状不明显，继续给与观察；有1例行翻修手术，重新行内固定并延长固定融合范围至L5/S1。结论 退变性腰椎侧凸治疗的首要目的是解除神经压迫，改善临床症状，重建腰椎序列的稳定性，这也是保证手术远期疗效的主要手段。固定和融合范围的选择需要综合分析患者临床表现和影像学资料，做到个体化治疗。 |
| 关键词：腰椎 脊柱侧凸 脊柱融合术 内固定器 |
| Operative management of degenerative lumbar scoliosis Fulltext |
| YANG Cheng GAO Chun-hua PENG Bao-gan |
| Department of Orthopaedics, Police General Hospital, Beijing 100039, China;Department of Orthopaedics, Police General Hospital, Beijing 100039, China;Department of Orthopaedics, Police General Hospital, Beijing 100039, China |
| Fund Project: |
| Abstract: |
| Objective To study the operative managements for degenerative lumbar scoliosis. Methods The clinical data of 36 patients with degenerative lumbar scoliosis, who received surgical treatment in our department from 2006 to 2011, were retrospectively reviewed. Personalization treatment was formulated based on the patient characteristics. Twenty cases received posterior lumbar laminectomy and depression with pedicle screw fixation, and 16 of them underwent posterior lumbar laminectomy and decompression and interbody fusion with pedicle screw fixation. The pre-and post-operation images, decompress manner and scope, and function grade were observed. Results The sciatica, intermittent claudication and low back pain were greatly released after operation. The entire internal fixation achieved satisfactory fusion and the fusion rate for the bone graft was 100%. In 2 cases L5 screws loose was found on both sides at 4 months and 11 months after operation; no special treatment was given and continuous follow-up found no aggravating signs. Three patients postoperative developing L5/S1 segment disc degeneration was improved, therein 2 cases of back pain symptoms were not obviously improved, and 1 patient underwent reoperation to extend the fixation fusion fixed and wide range to L5/S1. Conclusion For degenerated lumbar scoliosis patients, the most important treatment objective is to improve clinical symptoms through sufficient decompression of neural structures. Lumbar stabilization reconstruction and benign spinal biomechanics line conduce to long-term curative effect. Overall estimate of the clinical appearances and imageology characters are necessary when segments are needed to be fixed and fused. The strategy of the individualized treatment may be the best choice. |
| Keywords:Lumbar vertebrae Scoliosis Spinal fusion Internal fixators |
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