椎弓根系统内固定治疗腰椎退行性脊柱侧凸
|
摘要
退行性脊柱侧弯是一种特殊类型的脊柱侧弯,是指成年以后新出现的侧弯,而不是被忽视的原有侧弯的进展,除外继发于脊柱椎体器质性病变如肿瘤、创伤骨折、结核等原因引起的侧弯。目前随着社会老龄化的快速进展,退行性脊柱侧弯作为一严重退变的疾病,其发病率有明显增加趋势,是引起老年患者腰痛、下肢痛、间歇性跛行的一重要原因。本文就退行性脊柱侧弯的生理病理学、病因学说、辅助检查及特殊检查、临床表现、治疗等进展做一综述。并着重探讨了后路减压椎弓根系统内固定治疗退行性脊柱侧凸的临床效果。方法:回顾分析2001-2006年45例保守治疗无效的退行性脊柱侧凸病例行后路减压椎弓根系统矫形内固定植骨融合术的临床资料。观察手术后腰背痛和间歇性跛行等临床症状的改善率及手术前后Cobb角及椎体旋转的改善率。结果:术后患者的症状和体征均有明显改善,疼痛改善率95.6%,间歇性跛行改善率93.3%。术前Cobb角平均36.7°(27°-54°),术后Cobb角平均7.8°(0°-18°),改善率78.7%;腰椎前凸角术前平均-17.0°(-37°--15°),术后平均-36.4°(-45°--15°),平均矫正19.4°。随访6-78个月,平均34个月,未见矫正度明显丢失,无断钉及螺钉松动。结论:后路减压椎弓根系统内固定植骨融合治疗退行性腰椎侧凸是能取得比较满意的临床效果和畸形矫正效果的治疗方法。
Degenerative scoliosis is a kind of special scoliosis,it happens after you grew older,not the scoliosis that has been ignored.Except the scoliosis which cause by some spine disease such as tumour,traumatic fracture,tuberculosis.With the celerity aging of the society,degenerative scoliosis has become a serious degenerative disease.The incidence of this disease has a obvious increase trend and it is the very important reason of causing lumbago,pain of lower limbs,intermittence claudication.This test summarizes the physiology,pathology,pathogeny,assistant examine and special examine,clinic behave and treatment of degenerative scoliosis.and To investigate clinical results of posterior decompression and pedicle screws fixation of degenerative scoliosis.Method:From January 2001 to December 2006,45 cases with degenerative scoliosis were analyzed for their clinical data retrospectively.After conservation therapy was in vain,those patients had decompression and posterior correction fixation fusion.Cobb angle, lumbar pain relief rate and intermittent claudication relief rate were observed between preoperation and postoperation.
Result:All clinical manifestation was improved,pain relief rate was 95.6%,claudication relief rate was 93.3%postoperative.The average preoperative Cobb angle was 36.7°(27°～54°) 7.8°(0°-18°),the average postoperative Cobb angle was 7.8°(0°-18°),the average correcting rate of scoliosis was 78.7%.The average correcting ratio of lumbar lordosis was 88.9%.After an average 34 months(6-78 months) follow up,there vas no correction loss during long follow up,no broken screw and loosening screw.Conclusion:Surgical treatment of degenerative lumbar scoliosis can attain satisfied clinical effect and deformity correction.
Degenerative scoliosis is a kind of special scoliosis,it happens after you grew older,not the scoliosis that has been ignored.Except the scoliosis which cause by some spine disease such as tumour,traumatic fracture,tuberculosis.With the celerity aging of the society,degenerative scoliosis has become a serious degenerative disease.The incidence of this disease has a obvious increase trend and it is the very important reason of causing lumbago,pain of lower limbs,intermittence claudication.This test summarizes the physiology,pathology,pathogeny,assistant examine and special examine,clinic behave and treatment of degenerative scoliosis.and To investigate clinical results of posterior decompression and pedicle screws fixation of degenerative scoliosis.Method:From January 2001 to December 2006,45 cases with degenerative scoliosis were analyzed for their clinical data retrospectively.After conservation therapy was in vain,those patients had decompression and posterior correction fixation fusion.Cobb angle, lumbar pain relief rate and intermittent claudication relief rate were observed between preoperation and postoperation.
Result:All clinical manifestation was improved,pain relief rate was 95.6%,claudication relief rate was 93.3%postoperative.The average preoperative Cobb angle was 36.7°(27°～54°) 7.8°(0°-18°),the average postoperative Cobb angle was 7.8°(0°-18°),the average correcting rate of scoliosis was 78.7%.The average correcting ratio of lumbar lordosis was 88.9%.After an average 34 months(6-78 months) follow up,there vas no correction loss during long follow up,no broken screw and loosening screw.Conclusion:Surgical treatment of degenerative lumbar scoliosis can attain satisfied clinical effect and deformity correction.
引文
〔1〕 Guillaumat ,M.Histoirenaturelle des scolioses delenfance enfance alavieillesse.Natural history of scoliosis from childhood to old age) [J] . Bull2Acad2Natl2Med ,1999 ,183 (4) : 705-718 ; discussion 718-719.
〔2〕 Grubb S A , Lipscomb H J , Coonrad R W. Degenerative adult onsetscoliosis[J] . Spine 1988 , 13 (3) : 241-245.
〔3〕 Sapkas G,Efstathiou P Radiological parameters associated with theevolution of degener ative scoliosis [J] .Bull2Hosp2J t2Dis , 1996, 55(1) : 40-45.
〔4〕 Bridwell KH. Degenerative scoliosis[M] . In Bridwell KH , DeWaldRL (eds).The textbook of spinal surgery. Philadelphia : JB Lippin2cott , 1997 :728-741.
〔5〕 Grubb SA ,Lipscomb HJ .Diagnostic findings in painful adult scoliosis[J].Spine 1992 ,17 (5) : 518—527.
〔6〕 Marchesi DG, Aebi M. Pedicle fixation devices in the treatment of adult lumbar scoliosis[J].Spine , 1992 , 17 (8 Suppl) : S304-309.
〔7〕 Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J] .Clin20rthop ,2001 , (384) : 45—53.
〔8〕 Zurbriggen C , Markwalder TM. Long2term results in patients treated with posterior instrumentation and fusion for degenerative scoliosis of the lumbar spine [J] Acta2Neurochir2 (Wien) , 1999 , 141(1) : 21-26.
〔9〕 Kostuik J P.Adult scoliosis [M].In Bridwell KH , DeWald RL(eds).The textbook of spinal surgery.Philadelphia : JB Lippincott ,1997 :686-700.
〔10〕 McPhee IB , Swanson CE.The surgical management of degenera2tive lumbar scoliosis.Posterior instrumentation alone versus two stage surgery[J].Bull2Hosp2J t2Dis , 1998 , 57 (1) : 16-22.
[11]Nash CL,Goldstein JM,Wilham MR.Selection of lumbar fusion levels in adult idiopathic scoliosis patients[J].Presented at the annual meeting of the Scoliosis Research Society,Amsterdam,1989.
[12]Lonstein J E.Adult scoliosis In Bradford DS,lonstein J E,Moe J H,Oglivie JW,Winter RB(eds).Moe's textbook of scoliosis and related spinal deformities,2nd ed.Philadelphia:WB Saunder.,1987:249.
[13]Grubb S A,Lipscomb H J,Results of surgical treatment of painful adult scoliosis [J].Spine,1994,19(1):161921627.
[14]Pritchett JW,Bortel DT.Degenerative symptomatic lumbar scoliosis Spine,1993,18:7002703.
[15]Grubb SA,Lipscomb HJ.Diagnostic findings in painful adult scoliosis Spine,1992,17:5182527.
[16]Marchesi DG Aebi M.Pedicle fixation devices in the treatment of adult lumbar scoliosis[J].Spine 1992 17 Suppl 8 304-309.
[17]胡立萍,胡立香,魏玉芝.脊柱外科后路手术中俯卧位患者的护理要点[J].解放军护理杂志,2006,23(11):60261.
[18]高达玲,杨雪梅.脊柱侧弯螺钉内固定三维矫形术围手术期的护理[J].卫生职业教育,2006 24(14):139.
[19]候菲,王尉,魏琴,等.71例退行性脊柱侧弯三维矫形术患者的术后护理[J].中华护理杂志,2006,41(4):3032304.
[20]Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a health assessment analysis by SF-36[J].Spine,2003,28(6):602-606.
[21]Bridwell KH.Degenerative scoliosis.In:Bridwell KH,De Wald RL(eds).The Textbook of Spinal Surgery[M].Philadelphia:JB Lippincott,1997.728-741.
[22]Vanderpool DW,James JIP,Wynne D.Scoliosis in the elderly[J].J Bone Joint Surg(Am) 1969,51(3):446-455.
[23]张雪松,王岩,刘郑生,等.退行性脊柱侧凸的手术治疗及相关文献回顾[J]. 脊柱外利杂志2004,2(5):267-9
[24]Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res 2001;(384):45-53
[25]Bridwell KH.degenerative scoliosis//Bridwell KH.DeWald RL(eds).The textbook of spinal surgery.Philadelphia:JB Lippin 2 cott 1997:728-41
[26]Jennis LG,An HS.Spine update:lumbar foraminal stenosis.Spine 2000;3:389-94
[27]Liu H,lshihara H,Kanamori M,et al.Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis spine J 2003;3(6):524-98
[28]Guillaumat M.Histoirenaturelle des scoliosis delenfance enfance a lavicillesse.Natural history of scoliosis from childhood to old age.Bull Acad Natl Med1999;183(4):705-18
〔29〕Kostuik JP.Adult scoliosis.In:Bridwell KH,De Wald RL(eds).The Textbook of Spinal Surgery[M].Philadelphia:JB Lippincott,1997.686-700.
〔30〕McPhee IB,Swanson CE.The surgical management of degenerative lumbar scoliosis:posterior instrumentation alone versus two stage surgery[J].Bull Hosp Jt Dis,1998,57(1):16-22.
〔31〕Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J].Clin Orthop,2001,384:45-53.
〔32〕Nash CL,Goldstein JM,Wilham MR.Selection of lumbar fusion levels in adult idiopathic scoliosis patients:presented at the annual meeting of the Scoliosis Research Society[C].Amsterdam:1989.
〔33〕Katz JN,Lipson SJ,Lew RA,et al.Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis:patient selection,costs,and surgical outcomes[J].Spine,1997,22(10):1123-1131.
〔34〕曹洪海(综述)李明(审校).成人退行性脊柱侧凸的研究现状.中国矫行外 科杂志,2006,14:63-65.
[35]Barrios C,Lapuente JP,Sastre S.Treatment of chronic pain in adult scoliosis[J].Stud Health Technol Inform,2002,88:290-303.
[36]Bridwell KH.Degenerative scoliosis[M].In Bridwell KH.The textbook of spinal surgery.Philadelphia:JB Lippincott,1997:728-741.
[37]徐建桥;陈维善.成人退行性脊柱侧凸的研究进展.中国骨伤,2005,18:574-576
〔2〕 Grubb S A , Lipscomb H J , Coonrad R W. Degenerative adult onsetscoliosis[J] . Spine 1988 , 13 (3) : 241-245.
〔3〕 Sapkas G,Efstathiou P Radiological parameters associated with theevolution of degener ative scoliosis [J] .Bull2Hosp2J t2Dis , 1996, 55(1) : 40-45.
〔4〕 Bridwell KH. Degenerative scoliosis[M] . In Bridwell KH , DeWaldRL (eds).The textbook of spinal surgery. Philadelphia : JB Lippin2cott , 1997 :728-741.
〔5〕 Grubb SA ,Lipscomb HJ .Diagnostic findings in painful adult scoliosis[J].Spine 1992 ,17 (5) : 518—527.
〔6〕 Marchesi DG, Aebi M. Pedicle fixation devices in the treatment of adult lumbar scoliosis[J].Spine , 1992 , 17 (8 Suppl) : S304-309.
〔7〕 Simmons ED. Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J] .Clin20rthop ,2001 , (384) : 45—53.
〔8〕 Zurbriggen C , Markwalder TM. Long2term results in patients treated with posterior instrumentation and fusion for degenerative scoliosis of the lumbar spine [J] Acta2Neurochir2 (Wien) , 1999 , 141(1) : 21-26.
〔9〕 Kostuik J P.Adult scoliosis [M].In Bridwell KH , DeWald RL(eds).The textbook of spinal surgery.Philadelphia : JB Lippincott ,1997 :686-700.
〔10〕 McPhee IB , Swanson CE.The surgical management of degenera2tive lumbar scoliosis.Posterior instrumentation alone versus two stage surgery[J].Bull2Hosp2J t2Dis , 1998 , 57 (1) : 16-22.
[11]Nash CL,Goldstein JM,Wilham MR.Selection of lumbar fusion levels in adult idiopathic scoliosis patients[J].Presented at the annual meeting of the Scoliosis Research Society,Amsterdam,1989.
[12]Lonstein J E.Adult scoliosis In Bradford DS,lonstein J E,Moe J H,Oglivie JW,Winter RB(eds).Moe's textbook of scoliosis and related spinal deformities,2nd ed.Philadelphia:WB Saunder.,1987:249.
[13]Grubb S A,Lipscomb H J,Results of surgical treatment of painful adult scoliosis [J].Spine,1994,19(1):161921627.
[14]Pritchett JW,Bortel DT.Degenerative symptomatic lumbar scoliosis Spine,1993,18:7002703.
[15]Grubb SA,Lipscomb HJ.Diagnostic findings in painful adult scoliosis Spine,1992,17:5182527.
[16]Marchesi DG Aebi M.Pedicle fixation devices in the treatment of adult lumbar scoliosis[J].Spine 1992 17 Suppl 8 304-309.
[17]胡立萍,胡立香,魏玉芝.脊柱外科后路手术中俯卧位患者的护理要点[J].解放军护理杂志,2006,23(11):60261.
[18]高达玲,杨雪梅.脊柱侧弯螺钉内固定三维矫形术围手术期的护理[J].卫生职业教育,2006 24(14):139.
[19]候菲,王尉,魏琴,等.71例退行性脊柱侧弯三维矫形术患者的术后护理[J].中华护理杂志,2006,41(4):3032304.
[20]Schwab FJ,Smith VA,Biserni M,et al.Adult scoliosis:a health assessment analysis by SF-36[J].Spine,2003,28(6):602-606.
[21]Bridwell KH.Degenerative scoliosis.In:Bridwell KH,De Wald RL(eds).The Textbook of Spinal Surgery[M].Philadelphia:JB Lippincott,1997.728-741.
[22]Vanderpool DW,James JIP,Wynne D.Scoliosis in the elderly[J].J Bone Joint Surg(Am) 1969,51(3):446-455.
[23]张雪松,王岩,刘郑生,等.退行性脊柱侧凸的手术治疗及相关文献回顾[J]. 脊柱外利杂志2004,2(5):267-9
[24]Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis.Clin Orthop Relat Res 2001;(384):45-53
[25]Bridwell KH.degenerative scoliosis//Bridwell KH.DeWald RL(eds).The textbook of spinal surgery.Philadelphia:JB Lippin 2 cott 1997:728-41
[26]Jennis LG,An HS.Spine update:lumbar foraminal stenosis.Spine 2000;3:389-94
[27]Liu H,lshihara H,Kanamori M,et al.Characteristics of nerve root compression caused by degenerative lumbar spinal stenosis with scoliosis spine J 2003;3(6):524-98
[28]Guillaumat M.Histoirenaturelle des scoliosis delenfance enfance a lavicillesse.Natural history of scoliosis from childhood to old age.Bull Acad Natl Med1999;183(4):705-18
〔29〕Kostuik JP.Adult scoliosis.In:Bridwell KH,De Wald RL(eds).The Textbook of Spinal Surgery[M].Philadelphia:JB Lippincott,1997.686-700.
〔30〕McPhee IB,Swanson CE.The surgical management of degenerative lumbar scoliosis:posterior instrumentation alone versus two stage surgery[J].Bull Hosp Jt Dis,1998,57(1):16-22.
〔31〕Simmons ED.Surgical treatment of patients with lumbar spinal stenosis with associated scoliosis[J].Clin Orthop,2001,384:45-53.
〔32〕Nash CL,Goldstein JM,Wilham MR.Selection of lumbar fusion levels in adult idiopathic scoliosis patients:presented at the annual meeting of the Scoliosis Research Society[C].Amsterdam:1989.
〔33〕Katz JN,Lipson SJ,Lew RA,et al.Lumbar laminectomy alone or with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis:patient selection,costs,and surgical outcomes[J].Spine,1997,22(10):1123-1131.
〔34〕曹洪海(综述)李明(审校).成人退行性脊柱侧凸的研究现状.中国矫行外 科杂志,2006,14:63-65.
[35]Barrios C,Lapuente JP,Sastre S.Treatment of chronic pain in adult scoliosis[J].Stud Health Technol Inform,2002,88:290-303.
[36]Bridwell KH.Degenerative scoliosis[M].In Bridwell KH.The textbook of spinal surgery.Philadelphia:JB Lippincott,1997:728-741.
[37]徐建桥;陈维善.成人退行性脊柱侧凸的研究进展.中国骨伤,2005,18:574-576