1、经椎弓根内固定治疗退行性腰椎侧凸并椎管狭窄症王智方，胡侦明，郝 杰，陈 林，汪礼军，张晓军，甘 强，何 斌重庆医科大学附属第一医院脊柱外科中心，重庆市 400016Pedicle screw systems for degenerative lumbar scoliosis with stenosisWang Zhi-fang, Hu Zhen-ming, Hao Jie, Chen Lin, Wang Li-jun, Zhang Xiao-jun, Gan Qiang, He BinCenter for Spinal Surgery, First Hospital Affiliated to
2、 Chongqing Medical University, Chongqing 400016, China摘要 背景：研究认为单纯椎管减压治疗退行性腰椎侧凸并椎管狭窄难以获得长期疗效，因为单纯减压被视为一种医源性的腰椎失稳，从而加重腰椎畸形。目的：分析腰后路减压、矫形固定、融合治疗退行性腰椎侧凸并椎管狭窄，随访矫正角度评价。方法：退行性腰椎侧凸并椎管狭窄患者 23 例均采用腰后路减压、矫形固定、融合治疗。采用症状目测类比评估表、Oswestry 功能障碍指数评分表、SF-36 调查问卷、腰椎冠状位 Cobb 角对患者治疗前和末次随访时生活质量变化情况及矫正角度进行评价。结果与结论：患者随访均
3、超过 6 个月。Cobb 角治疗前平均(23.9411.4)，治疗后平均(10.286.93)；治疗后末次随访患者平均目测类比评分显著低于治疗前(P 0.05)；治疗后末次随访 Oswestry 功能障碍指数评分显著低于治疗前(P 0.05)，Oswestry 功能障碍指数评分改善优良率为 83.33%；治疗后 SF-36 调查问卷中的 8 个维度分值均较治疗前明显提高(P 0.05)。随访期间矫正角度无明显丢失，融合器无移位，内固定无断裂，植骨融合率 100%。中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：关键词 ： 植入物； 脊柱植
4、入物； 脊柱侧凸； 退行性脊椎侧弯； 椎管狭窄； 腰椎； 脊柱融合； 内固定器； Abstract：BACKGROUND: Simple vertebral canal decompression for degenerative lumbar scoliosis with stenosis cannot obtain long-period curative effects. Simple decompression is considered aiatrogenic destabilization of lumbar vertebra, and aggravates lumbar malf
5、ormation. OBJECTIVE: To analyze the effectiveness of posterior decompression, fixation and fusion in the treatment of degenerative lumbar scoliosis with stenosis and to evaluate corrective angle during the follow-up. METHODS: A total of 23 cases of degenerative lumbar scoliosis with stenosis underwe
6、nt posterior decompression, fixation and fusion. Visual Analogue Scale, Oswestry disability index, 36-Item Short-Form Health Survey scale and the Cobb angle on the lumbar coronal film were used to assess the changes in quality of life and corrective angle before treatment and during final follow-up.
7、 RESULTS AND CONCLUSION: All patients were followed up for at least 6 mouths. Mean Cobb angles were (23.9411.4) pretreatment and (10.286.93) posttreatment. Mean Visual Analogue Scale scores were significantly lower posttreatment than pretreatment (P 0.05). Oswestry disability index scores were signi
8、ficantly lower posttreatment than pretreatment (P 0.05). The excellent and good rate of Oswestry disability index score was 83.33%. The eight scaled scores of 36-Item Short-Form Health Survey scale were significantly higher posttreatment than pretreatment (P 0.05). During the follow-up, there was no
9、 obvious loss in corrective angle. Shift of interbody cages was not displaced. No internal fixator breakage appeared. The rate of fusion for bone graft was 100%.中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程全文链接：Key words： scoliosis; spinal stenosis; spinal fusion;中图分类号: R318 通讯作者: 胡侦明，博士，主任医师，重庆医科
10、大学附属第一医院脊柱外科中心，重庆市 400016 作者简介: 王智方，男，1984 年生，河北省丰润县人，汉族，2009 年佳木斯大学毕业，主要从事脊柱矫形研究。引用本文: 王智方,胡侦明 ,郝 杰等 . 经椎弓根内固定治疗退行性腰椎侧凸并椎管狭窄症J. 中国组织工程研究, 2014, 18(17): 2728-2733.Wang Zhi-fang,Hu Zhen-ming,Hao Jie et al. Pedicle screw systems for degenerative lumbar scoliosis with stenosisJ. Chinese Journal of Tissue Engineering Research, 2014, 18(17): 2728-2733.
