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    分期微创手术治疗成人重度退变性脊柱侧凸的中远期临床研究

    Mid-long-term clinical research of staged minimally invasive surgery in the treatment of severe adult degenerative scoliosis

      摘要
    • 摘要:
      目的通过分期微创手术的方式（侧路腰椎间融合术+后路经皮椎弓根螺钉固定）治疗成人重度退变性脊柱侧凸病人，评估分期微创手术在恢复病人冠状面和矢状面平衡中的临床疗效。
      方法回顾性分析行分期手术治疗的20例重度退变性脊柱侧凸病人的临床资料。记录手术时间、术中出血量及围手术期并发症。通过EOS成像系统来评估病人术前和术后站立位时冠状面、矢状面、骨盆参数变化。所有病人随访2~5年。比较术前和术后各项参数。
      结果一期经侧路腰椎椎间融合术，手术时间（231±48）min，术中出血（253±80）mL，第二期经皮椎弓根螺钉固定术，手术时间（155±33）min，术中出血（326±99）mL。两次手术间隔7~42 d。一期侧路腰椎间融合术后影像学参数均有明显改善，二期微创后路固定后这些参数得到了进一步改善。在冠状面上Cobb角从初始（43.1±7.3）°经一期手术后降至（11.4±4.0）°（P < 0.01），二期手术后降至（5.5±1.9）°（P < 0.01）。在矢状面上，腰椎前凸角从（16.8±8.4）°提高到（30.2±6.8）°（P < 0.01），二期手术后恢复到（37.1±4.0）°（P < 0.01）。矢状面垂直轴从（10.5±2.4）cm降至（5.3±2.1）cm（P < 0.01），二期手术后再降至（3.1±1.5）cm（P < 0.01）。在骨盆参数方面，骨盆投射角与腰椎前凸角匹配程度从（33.6±9.6）°下降至（17.8±4.5）°（P < 0.01），二期手术后降至（9.9±3.7）°（P < 0.01）。随访时视觉模拟评分腰痛、腿痛、Oswestry功能障碍指数评分均较治疗前明显改善（P < 0.01）。
      结论对于重度成人退变性脊柱侧凸病人，侧路椎体间融合术可同时纠正冠状面和矢状面平衡，分期微创手术疗效可靠。

       

      Abstract:
      ObjectiveTo evaluate the clinical efficacy of staged minimally invasive surgery in restoring coronal and sagittal balance in adult patients with severe degenerative scoliosis(SDS).
      MethodsThe clinical data of 20 adult SDS patients treated with staged surgery were retrospectively analyzed.The operative time, intraoperative blood loss and perioperative complications were recorded.The parameters of coronal plane, sagittal plane and pelvis at standing position before and after operation were evaluated using EOS imaging system.All patients were followed up for 3 to 5 years.The parameters in all cases between before and after operation were compared.
      ResultsThe operative time and intraoperative blood loss were(231±48)min and(253±80)mL in one-stage lumbar interbody fusion via lateral approach, respectively.The operative time and intraoperative blood loss were (155±33)min and(326±99)mL in two-stage percutaneous pedicle screw fixation, respectively.The interval between two operations was 7 to 42 d.The imaging parameters were significantly improved after one-stage lumbar interbody fusion via lateral approach, and the parameters were further improved after two-stage minimally invasive posterior fixation.On the coronal plane, the Cobb angle decreased from(43.1±7.3)° to (11.4±4.0)° after one-stage operation(P < 0.01), and(5.5±1.9)° after two-stage operation(P < 0.01).On the sagittal plane, the lumbar lordosis angle increased from(16.8±8.4)° to(30.2±6.8)° after one-stage operation(P < 0.01), and was restored to(37.1±4.0)åfter two-stage operation(P < 0.01).The vertical axis of sagittal plane decreased from(10.5±2.4)cm to (5.3±2.1)cm after one-stage operation(P < 0.01), and decreased to(3.1±1.5)cm after two-stage operation(P < 0.01).In terms of pelvic parameters, the matching degree of pelvic projection angle and lumbar lordosis angle decreased from(33.6±9.6)° to (7.8±4.5)åfter one-stage operation(P < 0.01) and(9.9±3.7)° after two-stage operation(P < 0.01).The visual analogue score and scores of low back pain, leg pain and Oswestry dysfunction index during following-up were significantly improved compared with before treatment(P < 0.01).
      ConclusionsFor severe adult degenerative scoliosis, the lateral lumbar interbody fusion can correct the balance of coronal and sagittal planes at the same time, and the effect of staged minimally invasive surgery is reliable.

       

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