背景：退变性腰椎侧凸患者多为老年人，可能合并其他疾患，造成修复耐受性较差。退变性腰椎侧凸多存在“责任椎体”，因而可以对其进行局部减压和选择性融合，这样可以达到神经减压、脊柱稳定效果，又相对微创。目的：探讨应用选择性椎间融合、局限神经减压结合椎弓根螺钉系统置入内固定修复退变性腰椎侧凸的效果。方法：回顾性分析53例退变性腰椎侧凸患者的临床特点，探讨修复适应证和禁忌证。采用选择性椎间融合、局限神经减压和椎弓根螺钉系统置入内固定的方案治疗，分析其修复效果和并发症。随访时采用Suk标准判断植骨融合情况；分别在治疗前和末次随访时采用日本骨科学会(JOA)推荐的下腰痛评分系统进行评估并计算疗效优良率；对比分析治疗前后矢状位和冠状位Cobb’s角。结果与结论：患者获得12-36个月随访。根据JOA 腰背痛评分，末次随访时患者的疗效优良率为89%。采用Suk标准评定椎间融合情况，融合率为94%。最后一次复查腰椎X射线摄片示：治疗后冠状面Cobb’s角平均(4.3±2.3)°(0°-13.5°)，侧凸矫正率为56%。治疗后矢状面Cobb’s角平均(45.1±12.5)°(10.4°-65.3°)，前凸矫正率为36%。修复后并发症包括：脑脊液漏2例，神经损伤2例，内固定器械失败1例，肺炎1例，症状性深静脉血栓3例。提示选择性椎间融合、局限性神经减压结合椎弓根螺钉钉棒系统置入内固定是修复退变性腰椎侧凸安全有效的方法，冠状面及矢状面上腰椎序列均可得到不同程度的重建，能够实现侧凸节段腰椎的稳定。%BACKGROUND:Degenerative lumbar scoliosis often appeared in the elderly, who may combine with other diseases, which can cause poor repair tolerance. Degenerative lumbar scoliosis commonly has a responsible vertebral body, so local decompression and selective fusion should be conducted. This can achieve nerve decompression, spinal stability, and is relatively minimaly invasive. OBJECTIVE:To explore the efficacy of selective interbody fusion, limited neural decompression combined with pedicle screw system fixation for degenerative lumbar scoliosis. METHODS:Clinical characteristics of 53 patients with degenerative lumbar scoliosis were retrospectively analyzed, and the indication and contraindication were investigated. Selective interbody fusion, and limited neural decompression combined with pedicle screw system fixation were performed in the patients. Treatment effect and complication were analyzed. During folow-up, Suk standard was utilized to judge bone graft fusion. Before treatment and during final folow-up, lower back pain score system recommended by the Japanese Orthopaedic Association was used for assessment, and the excelent and good rate of curative effects was calculated. Cobb’s angle on the sagittal and coronal positions was compared and analyzed before and after treatment. RESULTS AND CONCLUSION:The patients were folowed up for 12 to 36 months. According to low back pain score of Japanese Orthopaedic Association Scores, the excelent and good rate of curative effect was 89% during the last folow-up. According to Suk standard, the fusion rate of vertebra was 94%. The last X-ray films revealed that Cobb’s angle was averagely (4.3±2.3)° (0°-13.5°) on the coronal plane after treatment, and the correction rate of scoliosis was 56%. The Cobb’s angle was averagely (45.1±12.5)° (10.4°-65.3°) after treatment, and the correction rate of lordosis was 36%. Complications after repair consisted of cerebrospinal fluid leakage in two cases, nerve injury in two cases, instrumental failure in one case, and pulmonary infection in one case, and symptomatic deep venous thrombosis in three cases. These findings suggest that selective interbody fusion, and limited neural decompression combined with pedicle screw system fixation were effective and safe for degenerative lumbar scoliosis. The sequence of the lumbar vertebra on the coronal and the sagittal planes received reconstruction to different degrees, and could realize the stability of the lumbar vertebrae in the scoliosis.
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