Long-term clinical outcomes of selective segmental transforaminal lumbar interbody fusion and posterior spinal fusion for degenerative lumbar scoliosis

目的 探讨后路融合结合选择性节段经椎间孔腰椎椎间融合术(TLIF)治疗退变性脊柱侧凸的手术技巧和远期临床疗效.方法 回顾性分析从1999年1月至2007年12月于北京大学人民医院脊柱外科行后路融合结合选择性节段经椎间孔腰椎椎间融合术治疗退变性脊柱侧凸的95例患者资料.随访时间平均7.8(5～13)年.临床疗效评价包括Oswestry功能障碍指数(ODI)、视觉模拟评分(VAS)和患者满意度,影像学评价指标包括脊柱侧凸主弯Cobb角、顶椎偏移距离、顶椎旋转Nash-Moe分级、腰椎前凸角和胸腰交界区后凸角.结果 术前ODI评分平均(32.2±8.6)分,末次随访平均(11.1±6.8)分,术前VAS评分平均为(8.9±2.0)分,末次随访平均为(2.0±1.2)分,两者与术前比较差异均有统计学意义(均P＜0.05).末次随访患者满意度为88.2% (84/95).末次随访时,Cobb角、顶椎偏移距离、顶椎旋转Nash-Moe分级与术前相比均显著下降(P＜0.001);腰椎前凸角与术前相比显著增加(P＜0.001);胸腰交界区后凸角与术前相比差异无统计学意义(P＞0.05).术后ODI评分减少程度与腰椎前凸角增加呈正相关(r=0.62,P=0.01).术后远期并发症包括:断棒2例,冠状面交界区新发侧凸4例,L5～S1滑脱2例,L5～S1再狭窄5例,其中有11例患者行翻修手术.结论 后路融合结合选择性节段经椎间孔腰椎椎间融合术治疗退变性脊柱侧凸具有良好的远期临床疗效.选择性节段行TLIF不仅提高了椎间融合率,并有利于进一步恢复腰椎前凸角度、矫正椎体侧方移位和不对称椎间隙,从而取得更好的三维矫形效果和临床疗效.To explore the surgical techniques and long-term clinical outcomes of degenerative scoliosis (DS) with selective segmental transforaminal lumbar interbody fusion (TLIF) and posterior spinal fusion.Ninety-five patients with adult degenerative lumbar scoliosis undergoing posterior long fusion at our department from January 1999 to December 2007 were analyzed retrospectively. The average follow-up period was 7.8 (5-13) years. The clinical outcomes of Oswestry disability index (ODI), visual analog scale (VAS), patient satisfaction and such radiographic parameters as Cobb angle, apical vertebra translation (AVT), Nash-Moe grade, lumbar lordosis (LL) and thoracolumbar kyphosis (TLK) were evaluated.The clinical outcomes of ODI score and VAS significantly improved at the last visit (P < 0.05). The ODI score was 32.2 ± 8.6 before surgery and 11.1 ± 6.8 at the last visit. The VAS was 8.9 ± 2.0 before surgery and 2.0 ± 1.2 at the last visit. Patient satisfaction was 88.2% (84/95) at the last visit. At the final evaluation, Cobb's angle, apical vertebra translation and Nash-Moe grades decreased with a statistically significant difference (P < 0.001) compared with preoperative parameters.Lordotic angle had a significant increase than preoperative angle (P < 0.001). Thoracolumbar kyphosis showed no significant change (P > 0.05). Besides, a significant positive correlation existed between the decrease of ODI score and the increment of lumbar lordotic angle (r = 0.62, P = 0.01) .Long-term complications included broken rod (n = 2), coronal junctional scoliosis (n = 4), L5-S1 spondylolisthesis (n = 2), L5-S1 restenosis (n = 5). And 11 patients underwent reoperation.A combination of selective segmental TLIF and posterior spinal fusion is both safe and effective for degenerative scoliosis and excellent long-term clinical outcomes may be achieved. And selective segmental TLIF can facilitate solid fusion, improvement of lumbar lordosis, better correction of lateral spondylolisthesis and asymmetric disc space so as to yield better corrective effects and long-term clinical outcomes.北京市科委专项基金PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)0453577-35819