• 医学文献
  • 知识库
  • 评价分析
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
  • 临床诊疗知识库
  • 中医药知识库
  • 机构
  • 作者
热搜词:
换一批
论文 期刊
取消
高级检索

检索历史 清除

医学文献 >>
  • 全部
  • 中外期刊
  • 学位
  • 会议
  • 专利
  • 成果
  • 标准
  • 法规
知识库 >>
  • 临床诊疗知识库
  • 中医药知识库
评价分析 >>
  • 机构
  • 作者
热搜词:
换一批

微创技术治疗重度退变性腰椎侧凸的分期手术策略

Minimally invasive surgery for the severe degenerative lumbar scoliosis:two stage protocol

摘要:

目的 探讨重度退变性腰椎侧凸行微创手术治疗的可行性,并提出分期微创手术策略.方法 前瞻性研究2016年6月至2017年8月浙江大学第二医院的53例MISDEFⅢ型退变性腰椎侧凸患者,排除侧凸顶椎在L1/2及关节突关节自发融合的病例,行Ⅰ期多节段侧方腰椎融合术(CLIF)及侧方前柱松解重建技术(ACR),Ⅱ期后路微创固定的分期手术治疗.采集患者性别、年龄,随访时间、骨盆指数(PI),Ⅰ期及Ⅱ期手术出血量、手术时间,分期手术前后及末次随访时腰椎侧凸Cobb角、骨盆投射角与腰椎前凸角匹配程度(PI-LL)、脊柱矢状面轴(SVA)、冠状面平衡等影像学参数,疼痛视觉评分(VAS)及Oswestry功能障碍指数(ODI),主要及次要并发症.采用配对样本t检验分析评估分期微创手术疗效.结果 共入选53例,男性18例,女性35例,其中45例伴有神经症状及体征.所有患者均获得随访,随访时间平均11.5个月(6~20个月).总共行侧方腰椎融合节段数为168节段,其中行ACR为113个节段,平均每个ACR节段矢状面矫正角度为15.6°±6.3°(7°~28°).腰椎侧凸Cobb角Ⅰ期术后矫正率为55.4%,总的矫正率为75.6%,术前PI-LL为-32.8°± 14.9°,Ⅰ期术后改善至-9.9°±9.4°,Ⅱ期术后改善至-2.5°±9.4°,达到腰椎矢状面匹配状态.术前SVA为(5.7 ±4.1)cm,Ⅰ期矫正率达80.3%,总的矫正率达88.8%.末次随访时所有患者恢复冠状面及矢状面平衡,骨盆倾斜角(PT)、腰椎前凸角(LL)及冠状面距离均有明显改善.Ⅱ期手术经肌间隙椎间孔减压为13例(24.5%).后路微创固定方式中,经肌间隙多节段经椎间孔截骨+内固定例数为11例(20.8%),经肌间隙多节段内固定为36例(67.9%),单纯经皮椎弓根螺钉固定为6例(11.3%).平均固定节段数为(7.4 ±1.4)个.Ⅰ期及Ⅱ期手术出血量为(157 ±71)ml、(343 ±224)ml,手术时间为(214 ±60)min、(190 ±54)min.腰痛和腿痛VAS评分及ODI分期术后有明显缓解,差异有统计学意义(t=17.948、10.099、14.619,均P<0.001).结论 重度退变性腰椎侧凸微创手术治疗能获得很好的临床症状改善和畸形矫正;分期手术具有并发症少、患者耐受性增加等潜在优势.

更多
abstracts:

Objective To investigate the surgical outcome of minimally invasive surgery(MIS)for severe degenerative lumbar scoliosis(DLS)and put forward a two-stage MIS surgical strategy.Methods Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out,excluding the patients whose apex vertebrae of scoliosis was above L1/2level or whose facet joint got spontaneous fusion.Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment.Information was recorded,including gender,age,body mass index,follow-up period,pelvic incidence(PI),blood loss,operation time,visual analogue pain score(VAS),Oswestry disability index(ODI),complications in the perioperative period and follow-up period,and also the radiographic parameters such as scoliosis Cobb angle,the mismatch between pelvic incidence and lumbar lordosis(PI-LL),sagittalvertical axis(SVA),coronal balance(CB)before and after each stage of surgery or latest follow-up.The paired-samples t test was used to analyze the effectiveness of staging surgery.Results Fifty-three patients(18 males and 35 females)were included in this study.All patients had completed clinical and the follow-up records,with an average follow-up period of 11.52 months(6-20 months).A total of 168 segments fusions were performed with CLIF,113 segments were performed with anterior column realignment(ACR),the average correct angle was 15.6°±6.3°(7°-28°)in sagittal plane each level.After the stage Ⅰ surgery,lumbar scoliosis cobb had been corrected for 55.35%,after the stage Ⅱsurgery,rate of correction was 75.6%.PI-LL had been matched(-32.8°±14.9°to-2.5° ±9.4°),SVA was changed from 5.7 cm to 0.6 cm,the stage Ⅰrate of correction was 80.3 and stage Ⅱwas 88.8%,pelvic tilt(PT),lumbar lordosis(LL)and CB had been restored; 13(24.5%)patients were performed paraspinal approach transforaminal decompression.The posterior minimally invasive fixation indexes: 11(20.8%)patients were performed paraspinal approach transforaminal multi-segment transforaminal osteotomy(TFO)and internal fixation; 36(67.92%)cases were performed paraspinal approach transforaminal multi-segment fixation; 6(11.33%)patients were treated with percutaneous pedicle screw fixation.The average fixed segments was 7.4 ±1.4 in each patient.The blood loss of stage Ⅰ and stage Ⅱoperation was(157 ±71)ml,(343 ±224)ml,respectively.The operation time was(214 ±60)min,(190 ±54)min respectively in the two stage operations.The low back pain and leg pain VAS score and ODI improved after the stage Ⅰ and Ⅱ surgery(t=17.948,10.099,14.619,all P<0.001).Conclusions MIS for the severe degenerative lumbar scoliosis can achieve good clinical outcome and deformity correction.The two-stage protocol has the advantages of less complications and is well-tolerated.

More
作者: 徐正宽 [1] 陈刚 [1] 李方财 [1] 陈其昕 [1]
期刊: 《中华医学杂志》2018年98卷25期 1996-2001页 MEDLINEISTICPKUCSCD
栏目名称: 退变性脊柱侧凸的微创治疗
DOI: 10.3760/cma.j.issn.0376-2491.2018.25.006
发布时间: 2018-08-14
  • 浏览:348
  • 下载:246

加载中!

相似文献

  • 中文期刊
  • 外文期刊
  • 学位论文
  • 会议论文

加载中!

加载中!

加载中!

加载中!

扩展文献

特别提示:本网站仅提供医学学术资源服务,不销售任何药品和器械,有关药品和器械的销售信息,请查阅其他网站。

  • 客服热线:4000-115-888 转3 (周一至周五:8:00至17:00)

  • |
  • 客服邮箱:yiyao@wanfangdata.com.cn

  • 违法和不良信息举报电话:4000-115-888,举报邮箱:problem@wanfangdata.com.cn,举报专区

官方微信
万方医学小程序
new翻译 充值 订阅 收藏 移动端

官方微信

万方医学小程序

使用
帮助
Alternate Text
调查问卷