成人退变性腰椎侧弯的临床特点与影像学分析
|
摘要
目的1、通过对DLS患者调查分析研究,了解其流行病学及临床特点;2、通过影像学各参数的观察与测量,评价脊柱畸形程度,分析神经根受压部位及原因;3、通过对DLS患者JOA下腰痛评分与影像学参数之间的相关性研究,确定DLS患者影像学改变与JOA评分之间的相关性及其密切程度。
方法对2010.2-2011.3我院骨科门诊及住院就诊的DLS患者117例为横断面调查研究对象,其中男性45例,女性72例,年龄50-87岁,平均(64.05±9.05)岁,对所有患者进行详细的病史采集及体格检查,采用日本矫形外科学会(JOA)下腰痛评分标准,对患者神经功能和生活能力进行评分量化,及对影像学各参数(侧凸Cobb角、顶椎偏离度、侧弯累及的椎体数、腰椎前凸角、骶骨角、L3和L4椎体倾斜度、顶椎旋转度)进行观察测量,统计分析二者及各影像学参数之间的相关性,全面评价脊柱冠状面、矢状面及横轴面的畸形程度、了解神经受压情况。
结果1、在117例DLS患者中,其中伴有基础疾病史患者103例,占88%,基础疾病以心血管系统、内分泌系统、呼吸系统、泌尿系统、骨性关节炎及类风湿关节炎等疾病多见,且多数病人各种基础疾病并存;2、临床特点:诉有腰痛患者102例,占95.7%,男性患者42例,女性患者60例,腰痛病史1月-30年不等;伴有下肢神经根性症状患者65例,98根神经根受累,受累神经根以凹侧常见,凸侧神经根放射痛多于凹侧(78%),且以L5、S1为主;部分患者仅表现为双侧或单侧臀部疼痛麻木,未诉有下肢放射痛;7例患者诉有轻度小便功能障碍,2例患者有明显的尿失禁;间歇性跛行患者69例,其中男性31例,女性38例,疼痛表现在双下肢者23例,交替单肢者35例,单肢者11例;3、本组患者中,患病率男:女=1:1.6;82例(70.1%)凸向左侧,35例(29.9%)凸向右侧;不同性别间在侧弯方向上无统计学差异(χ2=0.050, P=0.823﹥0.05);4、腰椎侧弯椎体在X线片中特点:侧弯椎体范围3-6个,平均侧弯累计椎体4.6个;冠状面侧凸Cobb角10.2°-24.3°,平均(14.38±2.88)°;腰椎前凸角-8.3°-66.2°,平均(30.24±11.96)°;骶骨角9.2°-65.6°,平均(31.02±9.50)°;顶椎分布以L3、L4为主,椎体侧方滑移以L2、L3椎体为主;顶椎偏离度0.03-0.68,平均(0.23±0.11);顶椎椎体旋转度以Ⅰ度、Ⅱ度居多;5、神经根受压特点:在腰椎侧弯凹侧以L2、L3、L4神经根多见,凸侧以L5、S1神经根多见;神经根受压原因在腰椎侧弯凸侧与凹侧均已关节退变增生,黄韧带肥厚钙化多见;6、JOA评分与放射学参数之间相关性:腰椎前凸角、骶骨角、L3、L4椎体倾斜度、椎体旋转度、椎体侧方滑移与JOA下腰痛评分之间存在相关性。
结论1、DLS患者病情复杂,多数合并各种慢性系统疾病;腰椎侧弯范围内的椎体常常伴有骨质疏松及压缩性骨折,是引起患者腰痛症状加重、加速Cobb角增大的原因;2、L2、L3、L4神经根受压常见于腰椎侧弯凹侧,L5、S1神经根受压常见于腰椎侧弯凸侧;神经根受压原因以椎体间关节及关节突关节退变增生,黄韧带肥厚钙化、椎间盘塌陷突出常见;3、腰椎前凸角、骶骨角、L3、L4椎体倾斜度、顶椎椎体旋转及椎体侧方滑移与JOA下腰痛评分之间存在相关性,这些参数对JOA评分有重要意义,是评价患者临床表现较为可靠的指标。
Objective 1、Research on patients with DLS ,understand its epidemiology and cli -nical characteristics;2、Through various parameters of radiology of observation and measurement, the comprehensive evaluation of the spinal deformity, understand the location and cause of nerve compression;3、Through to DLS patients with JOA low back pain score and parameters correlation Correlation studies to determine the DLS radiological changing characteristics in patients with the JOA score and its closely related degree.
Methods Based on 2011.3 -2010.2 our outpatient department and the hospital medi-cal orthopaedics 117 cases for patients with DLS study for the cross-sectional survey object, 45 patients were male, female 72 cases, aged 50-87 years, average age (64.05±9.05) years ;We collected all patients detailed medical history and physical examination,to quantify theirs neurological function and life on the ability by the Japanese Orthopaed-ic surgery Association (JOA)scoring lower back pain rating criteria,And to observe and measure theirs radiographic parameters,to statistic analysis the correlation between JOA scoring and radiological parameters, to fully evaluate the spine coronal, sagittal and axial plane deformity, understand the situation of the nerve compression。The radiograp -hic parameters include Scoliosis Cobb angle, Apical vertebral deviation, The number of scoliosis involving the vertebral body, Lumbar lordosis, Sacral angle, L3、L4 vertebrel -tilt, Apical vertebral rotation and so on.
Results 1、DLS patients in 117 cases, of which 103 patients associated with basic diseases, accounting for 88%, basic diseases more common in the Cardiovascular systemEndocrine system,Respiratory system,Urinary system,Osteoarthritis,Rheumatoid arthri-tis and other diseases, and the majority of patients see more of basic diseases coexist;2、Clinical characteristics :102 patients complained of low back pain, accounting for 95.7%, men 42 patients, 60 cases of female patients, The history of low back pain ranging from one months to 30 yeas;Patients with lower extremity radicular symptoms in 65 cases, 98 nerve root involved, Affected nerve root with concave side common, convex side nerve root radiation pain than concave side (78%), and with the L5、S1 primarily。Some of these patients showed only bilateral or unilateral hip pain numb,nothave lower limb radiation pain;7 patients with mild urinate dysfunction lawsuit, 2 pati -ents had obvious incontinence ;69 cases of patients with intermittent claudication, 31 patients were male and 38 females, the pain reflected in the double lower limbs in 23 cases and 35 alternate single-limb Cases, one limb in 11 cases;3、This group of patients,the prevalence rate of male: female = 1:1.6; 82 cases (70.1%) convex to the left, 35 cases (29.9%) convex to the right; different sex in bending direction no significant diff -erence(χ2=0.050, P=0.823﹥0.05);4、Lumbar scoliosis vertebral in X-ray films char -acteristic:range of 3-6 vertebral scoliosis, scoliosis cumulative average of 4.6 vertebrae;Coronal Cobb angle of 10.2°-24.3°,the average (14.38±2.88)°; Lumbar lordosis -8.3°-66.2°,the average (30.24±11.96)°; Sacral angle of 9.2°-65.6°, the average (31.02±9.50)°;Apical vertebra distribution to L3、L4mainly ,Lateral sliding in L2、L3 vertebral primarily ; Apical vertebral deviation degree 0.03-0.68, the average (0.23±0.11); Apical vertebral rotation to gradeⅠ、Ⅱdegree mostly;5、Nerve root compression characteristics:In the lumbar scoliosis concave side to L2、L3、L4 nerve roots common, convex side of the L5、S1 nerve root common;Nerve root compression reason in lumbar scoliosis convex side and concave side were already Joint degeneration hyperplasia, Ligamentum flavum hypertrophy calcification;6、The JOA score and The
radiological parameters of the correlation:The lumbar lordosis Angle, sacral angle, L3、L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlated with The JOA.
Conclusion 1、The DLS patients with complex disease, most of all mergers of chronic system disease;Within the scope of scoliosis often accompanied by osteoporosis and vertebral compression fractures is a cause of fracture patient waist pain symptom aggravating, accelerate the Cobb Angle increased reason;2、L2、L3、L4 nerve root compression is common in lumbar scoliosis concave side,L5、S1 nerve root compressio-nis common in lumbar scoliosis convex side;Facet joint proliferation and degeneration, Ligamentum flavum hypertrophy calcification, Disc collapse often leads to nerve root compression;3、The lumbar lordosis, Sacral angle, The L3、L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlation with The JOA.The separameters are important to the JOA score was more reliable evaluation of clinical performance indicators.
方法对2010.2-2011.3我院骨科门诊及住院就诊的DLS患者117例为横断面调查研究对象,其中男性45例,女性72例,年龄50-87岁,平均(64.05±9.05)岁,对所有患者进行详细的病史采集及体格检查,采用日本矫形外科学会(JOA)下腰痛评分标准,对患者神经功能和生活能力进行评分量化,及对影像学各参数(侧凸Cobb角、顶椎偏离度、侧弯累及的椎体数、腰椎前凸角、骶骨角、L3和L4椎体倾斜度、顶椎旋转度)进行观察测量,统计分析二者及各影像学参数之间的相关性,全面评价脊柱冠状面、矢状面及横轴面的畸形程度、了解神经受压情况。
结果1、在117例DLS患者中,其中伴有基础疾病史患者103例,占88%,基础疾病以心血管系统、内分泌系统、呼吸系统、泌尿系统、骨性关节炎及类风湿关节炎等疾病多见,且多数病人各种基础疾病并存;2、临床特点:诉有腰痛患者102例,占95.7%,男性患者42例,女性患者60例,腰痛病史1月-30年不等;伴有下肢神经根性症状患者65例,98根神经根受累,受累神经根以凹侧常见,凸侧神经根放射痛多于凹侧(78%),且以L5、S1为主;部分患者仅表现为双侧或单侧臀部疼痛麻木,未诉有下肢放射痛;7例患者诉有轻度小便功能障碍,2例患者有明显的尿失禁;间歇性跛行患者69例,其中男性31例,女性38例,疼痛表现在双下肢者23例,交替单肢者35例,单肢者11例;3、本组患者中,患病率男:女=1:1.6;82例(70.1%)凸向左侧,35例(29.9%)凸向右侧;不同性别间在侧弯方向上无统计学差异(χ2=0.050, P=0.823﹥0.05);4、腰椎侧弯椎体在X线片中特点:侧弯椎体范围3-6个,平均侧弯累计椎体4.6个;冠状面侧凸Cobb角10.2°-24.3°,平均(14.38±2.88)°;腰椎前凸角-8.3°-66.2°,平均(30.24±11.96)°;骶骨角9.2°-65.6°,平均(31.02±9.50)°;顶椎分布以L3、L4为主,椎体侧方滑移以L2、L3椎体为主;顶椎偏离度0.03-0.68,平均(0.23±0.11);顶椎椎体旋转度以Ⅰ度、Ⅱ度居多;5、神经根受压特点:在腰椎侧弯凹侧以L2、L3、L4神经根多见,凸侧以L5、S1神经根多见;神经根受压原因在腰椎侧弯凸侧与凹侧均已关节退变增生,黄韧带肥厚钙化多见;6、JOA评分与放射学参数之间相关性:腰椎前凸角、骶骨角、L3、L4椎体倾斜度、椎体旋转度、椎体侧方滑移与JOA下腰痛评分之间存在相关性。
结论1、DLS患者病情复杂,多数合并各种慢性系统疾病;腰椎侧弯范围内的椎体常常伴有骨质疏松及压缩性骨折,是引起患者腰痛症状加重、加速Cobb角增大的原因;2、L2、L3、L4神经根受压常见于腰椎侧弯凹侧,L5、S1神经根受压常见于腰椎侧弯凸侧;神经根受压原因以椎体间关节及关节突关节退变增生,黄韧带肥厚钙化、椎间盘塌陷突出常见;3、腰椎前凸角、骶骨角、L3、L4椎体倾斜度、顶椎椎体旋转及椎体侧方滑移与JOA下腰痛评分之间存在相关性,这些参数对JOA评分有重要意义,是评价患者临床表现较为可靠的指标。
Objective 1、Research on patients with DLS ,understand its epidemiology and cli -nical characteristics;2、Through various parameters of radiology of observation and measurement, the comprehensive evaluation of the spinal deformity, understand the location and cause of nerve compression;3、Through to DLS patients with JOA low back pain score and parameters correlation Correlation studies to determine the DLS radiological changing characteristics in patients with the JOA score and its closely related degree.
Methods Based on 2011.3 -2010.2 our outpatient department and the hospital medi-cal orthopaedics 117 cases for patients with DLS study for the cross-sectional survey object, 45 patients were male, female 72 cases, aged 50-87 years, average age (64.05±9.05) years ;We collected all patients detailed medical history and physical examination,to quantify theirs neurological function and life on the ability by the Japanese Orthopaed-ic surgery Association (JOA)scoring lower back pain rating criteria,And to observe and measure theirs radiographic parameters,to statistic analysis the correlation between JOA scoring and radiological parameters, to fully evaluate the spine coronal, sagittal and axial plane deformity, understand the situation of the nerve compression。The radiograp -hic parameters include Scoliosis Cobb angle, Apical vertebral deviation, The number of scoliosis involving the vertebral body, Lumbar lordosis, Sacral angle, L3、L4 vertebrel -tilt, Apical vertebral rotation and so on.
Results 1、DLS patients in 117 cases, of which 103 patients associated with basic diseases, accounting for 88%, basic diseases more common in the Cardiovascular systemEndocrine system,Respiratory system,Urinary system,Osteoarthritis,Rheumatoid arthri-tis and other diseases, and the majority of patients see more of basic diseases coexist;2、Clinical characteristics :102 patients complained of low back pain, accounting for 95.7%, men 42 patients, 60 cases of female patients, The history of low back pain ranging from one months to 30 yeas;Patients with lower extremity radicular symptoms in 65 cases, 98 nerve root involved, Affected nerve root with concave side common, convex side nerve root radiation pain than concave side (78%), and with the L5、S1 primarily。Some of these patients showed only bilateral or unilateral hip pain numb,nothave lower limb radiation pain;7 patients with mild urinate dysfunction lawsuit, 2 pati -ents had obvious incontinence ;69 cases of patients with intermittent claudication, 31 patients were male and 38 females, the pain reflected in the double lower limbs in 23 cases and 35 alternate single-limb Cases, one limb in 11 cases;3、This group of patients,the prevalence rate of male: female = 1:1.6; 82 cases (70.1%) convex to the left, 35 cases (29.9%) convex to the right; different sex in bending direction no significant diff -erence(χ2=0.050, P=0.823﹥0.05);4、Lumbar scoliosis vertebral in X-ray films char -acteristic:range of 3-6 vertebral scoliosis, scoliosis cumulative average of 4.6 vertebrae;Coronal Cobb angle of 10.2°-24.3°,the average (14.38±2.88)°; Lumbar lordosis -8.3°-66.2°,the average (30.24±11.96)°; Sacral angle of 9.2°-65.6°, the average (31.02±9.50)°;Apical vertebra distribution to L3、L4mainly ,Lateral sliding in L2、L3 vertebral primarily ; Apical vertebral deviation degree 0.03-0.68, the average (0.23±0.11); Apical vertebral rotation to gradeⅠ、Ⅱdegree mostly;5、Nerve root compression characteristics:In the lumbar scoliosis concave side to L2、L3、L4 nerve roots common, convex side of the L5、S1 nerve root common;Nerve root compression reason in lumbar scoliosis convex side and concave side were already Joint degeneration hyperplasia, Ligamentum flavum hypertrophy calcification;6、The JOA score and The
radiological parameters of the correlation:The lumbar lordosis Angle, sacral angle, L3、L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlated with The JOA.
Conclusion 1、The DLS patients with complex disease, most of all mergers of chronic system disease;Within the scope of scoliosis often accompanied by osteoporosis and vertebral compression fractures is a cause of fracture patient waist pain symptom aggravating, accelerate the Cobb Angle increased reason;2、L2、L3、L4 nerve root compression is common in lumbar scoliosis concave side,L5、S1 nerve root compressio-nis common in lumbar scoliosis convex side;Facet joint proliferation and degeneration, Ligamentum flavum hypertrophy calcification, Disc collapse often leads to nerve root compression;3、The lumbar lordosis, Sacral angle, The L3、L4 vertebral inclination, vertebral rotation degree and vertebral lateral sliding have correlation with The JOA.The separameters are important to the JOA score was more reliable evaluation of clinical performance indicators.
引文
[1] Ploumis A,Transfledt EE,Denis F. Degenerative lumbar scoliosis associated with spinal stenosis[J].Spine J, 2007, 7(4):428-436.
[2]贾连顺,蔡卫华.退变性腰椎侧凸现代概念及治疗策略[J].国外医学.骨科学分册.2005,26(6).
[3] The adult scoliosis[J] Eur Spine J,2005,14(10):925-948.
[4] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and Surgical treatment [J] Orthop Traumatol,2006,7(2):67-71.
[5] Benner B,Ehni G. Degenerative lumbar scoliosis[J].Spine,1979,4(6):548-552.
[6] Aebi M. The adult scoliosis [J]. Eur Spine J,2005,14(10):925-948.
[7] Vanderpoor DW,Jams JI,Wynne-Dravies R. socliosis in the elderly [J]Bone Jointsurf An 1969,51(3):446-455.
[8] Perennou D,Marcelli C,Hersson C,et al. Adult lumbar scoliosis,Epidemiologic aspects in a low-back pain popular [J].Spine,1994,19(2):123-128.
[9] Kobayashi T,Atsuta Y,Takemitsu M,et al. prospective study of develop scolios is in a community based cohort [J].Spine,2006,31(2):178-182.
[10] Shufflebarger H,Suk SI,Mardjetko S. Debate: determining the upper instrumentedvertebra in the management of adult degenerative scoliosis : stopping at T10 Versus L1 [J].Spine,2006,31(19):185-194.
[11]郭俊杰,陈伯华,腰腿痛患者中退行性腰椎侧凸的调查[J]. cnki.2009-06.
[12] Guillaumat M. Natural history of scoliosis from childhood to old age [J]. Bull Acad Natl Med,1999,183(4):052-718.
[13] Murata Y,Takahashi K,Hanaoka E. Changes in scoliosis curature and lordotic angle during the early phase of degenerative lumbar scoliosis [J]. Spine,2002,27(26):822-273.
[14] Adams MA.The mechanical of lumbar anophy joints [J]. Spints,1983,8:327.
[15] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2):67-71.
[16] Gupta MC. Degenerative scoliosis. Options for surgical management [J]. Orthop Traumatol,2003,34(2) :2692279.
[17] shnan KM,Nwewy MI. Rheumatology(Oxfor),2001:40(20):427-1428.
[18] Daffner SD,Vaccaro AR. Adult degenerative lumbar scoliosis [J]. Orthop Trauma-tol,2003,32(2):77282.
[19] Grubb SA,Lipscomb HJ. Diagnostic findings in painful adult scoliosis [J]. Spine,1992,17(5):518-27.
[20] Hasegawa T,An HS,et al. Lumbar foraminal stenosis: critical heights of the itervertebral discs and foramina [J]. Bone Joint Surg(Am),1995,77:32238
[21]王岩,张雪松,张永刚等.退变性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2):170-173.
[22] Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis [J]. ClinOrthop,2001,384:45-53.
[23] Liu H,Ishihara H,Kanamori M. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine J,2003,3(6):5242529.
[24] Schwab FJ,Smith VA,Bisemim M. et al. Adult Scoliosis;aquantitative radiogra-paic and clinical Analysis [J] spine,2002,27(4):387-392.
[25] Glassman SD,Bridwell K,Dimar R,et al. The impact of positive sagittal balance in adult spinal deformity [J].Spine,2005,30(18):2024-2029.
[1] The adult scoliosis [J]. Eur Spine J,2005,14(10):925-948.
[2] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2): 67-71.
[3] Benner B,Ehni G. Degenerative lumbar scoliosis [J].Spine,1979,4(6): 548-552.
[4] Ploumis A,Transfledt EE,Denis F. Degenerative lumbar scoliosis associated with spinal stenosis [J].Spine J,2007,7(4): 428-436.
[5] Vanderpoor DW,Jams JI,Wynne-Dravies R. socliosis in the elderly [J]. Bone Join surf An 1969;51(3): 446-455
[6] Perennou D,Marcelli C,Hersson C,et al. Adult lumbar scoliosis,Epidemiologic aspects in a low back pain Popular [J]. Spine,1994,19(2) : 123-128.
[7] Kobayashi T,Atsuta Y,Takemitsu M,et al. prospective study of develope scoliosis in a community based cohort [J]. Spine,2006,31(2): 178-182.
[8] Shufflebarger H,Suk SI,Mardjetko S. Debate:determining the upper instrumented vertebra in the management of adult generative scoliosis: stopping at T10 versus L1 [J]. Spine,2006,31( Suppl 19) : 185-194.
[9]郭俊,陈伯华,腰腿痛患者中退行性腰椎侧凸的调查[J]. cnki.2009-06
[10] Guillaumat M. Natural history of scoliosis from childhood to old age [J]. Bull Acad Natl Med,1999,183 (4) :705-718.
[11] Murata Y,Takahashi K,Hanaoka E. Changes in scoliosis curature and lordotic angle during the early phase of degenerative lumbar scoliosis[J]. Spine,2002,27(26):822-273.
[12] Grubb SA,Lipscomb HJ. Diagnostic findings in painful adult scoliosis [J]. Spine, 199217 (5): 518-527.
[13] Pritchett JW,Bortel DT. Degenerative symptomatic lumbar scoliosis [J].Spine, 1993,18(3) : 700-703.
[14] Adams MA.The mechanical of lumbar anophy joints [J]. Spine,1983,8:327.
[15] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2): 67-71.
[16]贾连顺,蔡卫华,退变性腰椎侧凸现代概念及治疗策略[J].国外医学.骨科学分册.2005,26(6).
[17] shnan KM,Nwewy MI. Rheumatology(Oxfor),2001:40(20): 1427-1428
[18]王岩,张雪松,张永刚等.退变性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2): 170-173.
[19] Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with asso--ciated scoliosis [J]. Clinical Orthop,2001,384:45-53.
[20] Liu H,Ishihara H,Kanamori M. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine J,2003, 3(6):524-529.
[21] Daffner SD,Vaccaro AR. Adult degenerative lumbar scoliosis [J]. Am J Orthop,2003,32 (2):77282.
[22] Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis [J]. Clinical Orthop Relates 2001,384:45-53.
[23] Avraam P,Ensor.E,Denis F. Degenerative lumbar scoliosis associated with spinal Stenosis [J]. Spine J 2007,1(1):1-8
[24] Evcik D,Yucel A. Lumbar lordosis in acute and chronic low back pain patients [J]. Rhenmatol Int. 2003(4):163-165
[25] Hasegawa T,An HS,et al. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. J Bone Joint Surg(Am),1995,77:32238
[26] Schwab FS,Smith A,Bisemi M,et al. Adult Scoliosis;aquantitative radiologic -al and clinical Analysis [J]. spine,2002,27(4):387-392
[27] Toyone T,Tanaka T,Kato D,et al. Anatomic changes in lateral spondylolisthesisassociated with adult lumbar scoliosis [J]. Spine,2005,30(22): E671-675.
[28] Hansraj KK,OLeary PF,Cammisa R,et a1. Decompression,fusion and instruention surgery for complex : lumber spinal stenosis [J]. Clinical Orhop Relates,2001,(384):18-25.
[2]贾连顺,蔡卫华.退变性腰椎侧凸现代概念及治疗策略[J].国外医学.骨科学分册.2005,26(6).
[3] The adult scoliosis[J] Eur Spine J,2005,14(10):925-948.
[4] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and Surgical treatment [J] Orthop Traumatol,2006,7(2):67-71.
[5] Benner B,Ehni G. Degenerative lumbar scoliosis[J].Spine,1979,4(6):548-552.
[6] Aebi M. The adult scoliosis [J]. Eur Spine J,2005,14(10):925-948.
[7] Vanderpoor DW,Jams JI,Wynne-Dravies R. socliosis in the elderly [J]Bone Jointsurf An 1969,51(3):446-455.
[8] Perennou D,Marcelli C,Hersson C,et al. Adult lumbar scoliosis,Epidemiologic aspects in a low-back pain popular [J].Spine,1994,19(2):123-128.
[9] Kobayashi T,Atsuta Y,Takemitsu M,et al. prospective study of develop scolios is in a community based cohort [J].Spine,2006,31(2):178-182.
[10] Shufflebarger H,Suk SI,Mardjetko S. Debate: determining the upper instrumentedvertebra in the management of adult degenerative scoliosis : stopping at T10 Versus L1 [J].Spine,2006,31(19):185-194.
[11]郭俊杰,陈伯华,腰腿痛患者中退行性腰椎侧凸的调查[J]. cnki.2009-06.
[12] Guillaumat M. Natural history of scoliosis from childhood to old age [J]. Bull Acad Natl Med,1999,183(4):052-718.
[13] Murata Y,Takahashi K,Hanaoka E. Changes in scoliosis curature and lordotic angle during the early phase of degenerative lumbar scoliosis [J]. Spine,2002,27(26):822-273.
[14] Adams MA.The mechanical of lumbar anophy joints [J]. Spints,1983,8:327.
[15] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2):67-71.
[16] Gupta MC. Degenerative scoliosis. Options for surgical management [J]. Orthop Traumatol,2003,34(2) :2692279.
[17] shnan KM,Nwewy MI. Rheumatology(Oxfor),2001:40(20):427-1428.
[18] Daffner SD,Vaccaro AR. Adult degenerative lumbar scoliosis [J]. Orthop Trauma-tol,2003,32(2):77282.
[19] Grubb SA,Lipscomb HJ. Diagnostic findings in painful adult scoliosis [J]. Spine,1992,17(5):518-27.
[20] Hasegawa T,An HS,et al. Lumbar foraminal stenosis: critical heights of the itervertebral discs and foramina [J]. Bone Joint Surg(Am),1995,77:32238
[21]王岩,张雪松,张永刚等.退变性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2):170-173.
[22] Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis [J]. ClinOrthop,2001,384:45-53.
[23] Liu H,Ishihara H,Kanamori M. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine J,2003,3(6):5242529.
[24] Schwab FJ,Smith VA,Bisemim M. et al. Adult Scoliosis;aquantitative radiogra-paic and clinical Analysis [J] spine,2002,27(4):387-392.
[25] Glassman SD,Bridwell K,Dimar R,et al. The impact of positive sagittal balance in adult spinal deformity [J].Spine,2005,30(18):2024-2029.
[1] The adult scoliosis [J]. Eur Spine J,2005,14(10):925-948.
[2] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2): 67-71.
[3] Benner B,Ehni G. Degenerative lumbar scoliosis [J].Spine,1979,4(6): 548-552.
[4] Ploumis A,Transfledt EE,Denis F. Degenerative lumbar scoliosis associated with spinal stenosis [J].Spine J,2007,7(4): 428-436.
[5] Vanderpoor DW,Jams JI,Wynne-Dravies R. socliosis in the elderly [J]. Bone Join surf An 1969;51(3): 446-455
[6] Perennou D,Marcelli C,Hersson C,et al. Adult lumbar scoliosis,Epidemiologic aspects in a low back pain Popular [J]. Spine,1994,19(2) : 123-128.
[7] Kobayashi T,Atsuta Y,Takemitsu M,et al. prospective study of develope scoliosis in a community based cohort [J]. Spine,2006,31(2): 178-182.
[8] Shufflebarger H,Suk SI,Mardjetko S. Debate:determining the upper instrumented vertebra in the management of adult generative scoliosis: stopping at T10 versus L1 [J]. Spine,2006,31( Suppl 19) : 185-194.
[9]郭俊,陈伯华,腰腿痛患者中退行性腰椎侧凸的调查[J]. cnki.2009-06
[10] Guillaumat M. Natural history of scoliosis from childhood to old age [J]. Bull Acad Natl Med,1999,183 (4) :705-718.
[11] Murata Y,Takahashi K,Hanaoka E. Changes in scoliosis curature and lordotic angle during the early phase of degenerative lumbar scoliosis[J]. Spine,2002,27(26):822-273.
[12] Grubb SA,Lipscomb HJ. Diagnostic findings in painful adult scoliosis [J]. Spine, 199217 (5): 518-527.
[13] Pritchett JW,Bortel DT. Degenerative symptomatic lumbar scoliosis [J].Spine, 1993,18(3) : 700-703.
[14] Adams MA.The mechanical of lumbar anophy joints [J]. Spine,1983,8:327.
[15] Faldini C,Pagkrati S,Grandi G,et al. Degenerative lumbar scoliosis: features and surgical treatment [J]. Orthop Traumatol,2006,7(2): 67-71.
[16]贾连顺,蔡卫华,退变性腰椎侧凸现代概念及治疗策略[J].国外医学.骨科学分册.2005,26(6).
[17] shnan KM,Nwewy MI. Rheumatology(Oxfor),2001:40(20): 1427-1428
[18]王岩,张雪松,张永刚等.退变性腰椎侧凸性椎管狭窄神经根受压特点[J].中国医学科学院学报,2005,27(2): 170-173.
[19] Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with asso--ciated scoliosis [J]. Clinical Orthop,2001,384:45-53.
[20] Liu H,Ishihara H,Kanamori M. Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis. Spine J,2003, 3(6):524-529.
[21] Daffner SD,Vaccaro AR. Adult degenerative lumbar scoliosis [J]. Am J Orthop,2003,32 (2):77282.
[22] Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis [J]. Clinical Orthop Relates 2001,384:45-53.
[23] Avraam P,Ensor.E,Denis F. Degenerative lumbar scoliosis associated with spinal Stenosis [J]. Spine J 2007,1(1):1-8
[24] Evcik D,Yucel A. Lumbar lordosis in acute and chronic low back pain patients [J]. Rhenmatol Int. 2003(4):163-165
[25] Hasegawa T,An HS,et al. Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. J Bone Joint Surg(Am),1995,77:32238
[26] Schwab FS,Smith A,Bisemi M,et al. Adult Scoliosis;aquantitative radiologic -al and clinical Analysis [J]. spine,2002,27(4):387-392
[27] Toyone T,Tanaka T,Kato D,et al. Anatomic changes in lateral spondylolisthesisassociated with adult lumbar scoliosis [J]. Spine,2005,30(22): E671-675.
[28] Hansraj KK,OLeary PF,Cammisa R,et a1. Decompression,fusion and instruention surgery for complex : lumber spinal stenosis [J]. Clinical Orhop Relates,2001,(384):18-25.