摘要目的 探讨短节段与长节段固定融合术式在65岁以上老年人腰椎退变性侧凸症手术治疗中的可靠性、适应证选择及手术后的效果.方法 回顾性分析自2005年6月至2010年10月经手术治疗的38例腰椎退变性侧弯的矫正效果、并发症和随访结果.其病程6～120个月,平均45.2个月.对术前Cobb角＜20°,伴严重的神经根刺激和(或)受损者的13例患者,行选择性椎管或神经根管减压,椎间盘摘除,后路横突及椎板植骨融合,短节段椎弓根钉棒系统固定；对Cobb角＞20°的25例患者,行长节段固定侧弯矫正,选择性椎管或神经根管减压,植骨融合.结果 短节段融合(2.8±0.7)个节段,长节段融合(5.1±1.4)节段.短节段组纠正Cobb's角平均40％,长节段组纠正Cobb's角平均67％.疼痛缓解率88.3％,92％患者自诉生活质量得到明显改善,平均随访37个月(6～48个月),随访期间矫正度数及椎间隙高度无丢失,融合器无移位.结论 对于Cobb角＜20°,尽管伴严重的神经根刺激和(或)受损,但冠状位及矢状位上畸形不明显的患者,用短节段固定融合疗效满意；对于Cobb角＞20°伴明显的额状面旋转及侧方滑移＞3mm的侧凸,脊柱冠状面和矢状面失平衡的患者,用长节段固定融合疗效满意.老年患者病程长、往往伴随多器官疾病,应注意将手术创伤减少到最低程度,术后积极加强功能锻炼.

abstractsObjective To explore the indications,surgical techniques and prognostic factors of short fusion versus long fusion for elder patients with degenerative lumbar scoliosis.Methods Thirty-eight patients undergoing different kinds of surgical procedures for lumbar spinal scoliosis between June 2005 and October 2010 were recruited for this retrospective study.The mean patient age at surgery was 64.2 years (range:61 -75).The short fusion group included 13 patients and the long fusion group 25 patients.Results There were a variety of treatment methods of degenerative scoliosis based on the symptomatology and radiological measurements of scoliosis and stenosis.Thirty-eight patients were followed up for an average of 37 months.The number of fused levels was 2.8 ±0.7 segments in the short fusion group versus 5.1 ± 1.4 in the long fusion group.The average preoperative Cobb angle was 18.6°(range:12 -27)in the short fusion group versus 33.5°(range:3 -42)in the long fusion group.The correction of Cobb angle averaged 40％ in the short fusion group versus 67％ in the long fusion group.Clinical symptoms and functional tolerance for daily activities improved postoperatively.Radiographic evaluations showed reduced deformity on the frontal and sagittal planes.There were no infections,pseudoarthrosis,instrument-related failures or reoperations.Conclusions Long segment fusion is superior to its short segment counterpart in correcting scoliotic curvature and coronal imbalance and improving rotational subluxation of apical vertebra.Careful perioperative preparation is essential in the treatment of elder patients with lumbar spinal scoliosis.