本文關鍵詞：Lenke-Silva分型在退變性脊柱側(cè)彎治療的臨床應用及療效分析　出處：《寧夏醫(yī)科大學》2016年碩士論文　論文類型：學位論文

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【摘要】：目的評估并分析Lenke-Silva分型在國人退變性脊柱側(cè)彎臨床應用中的指導作用與意義,以期為國人退變性脊柱側(cè)彎的臨床診療提供理論參考。方法回顧性分析2011年3月--2014年9月在我院接受退變性脊柱側(cè)彎手術治療的患者65例。依據(jù)Lenke-Silva分型將所有病例資料進行分級,其中1級7例、2級14例、3級15例、4級13例、5級10例、6級6例。分型中1級病例行單純減壓;2級病例行后路減壓并短節(jié)段融合固定;3級病例中3例行短節(jié)段融合固定,12例行側(cè)彎矯形;4級病例中10例行后路減壓、融合固定后凸矯形、恢復腰椎前凸,3例延伸固定至胸椎;5級行后路減壓、矯形、長節(jié)段融合固定至胸椎9例,行截骨矯形1例;6級均行截骨矯形治療。比較患者術前術后矢狀面軸向垂線(sagittal vertical axis,SVA)、自然站立位時C7鉛垂線至骶骨中線鉛垂線偏移距離(central sacral vertical line distance,C7PL-CSVL)、腰椎Cobb角、前凸角(lumbar lordosis,LL)、骨盆入射角(pelvic incidence angle,PI)、骨盆傾斜角(pelvic tilt angle,PT)、骨盆入射角與腰椎前凸角匹配度(PI—LL)影像學參數(shù)的改變情況;將患者術前術后Oswestry功能障礙指數(shù)(ODI)、疼痛視覺模擬評分(visual analogue scale,VAS)、脊柱側(cè)凸協(xié)會22項問卷表(scoliosis research society-22 SRS-22)評分進行比較,了解術后疼痛、功能及生活質(zhì)量變化。結(jié)果所有患者均獲得隨訪,最短隨訪11個月,最長隨訪4年,平均15.3月,所有患者術后6個月及末次隨訪疼痛、功能及生活質(zhì)量評分(VAS、ODI、SRS-22)較術前比較均獲得顯著改善,統(tǒng)計學比較P0.05;影像學評估:1-2級患者術后6個月、末次隨訪Cobb角、腰椎前凸角、骨盆參數(shù)(PT、PI-LL)與術前比較無顯著差異(P0.05);3-6級患者術后6個月、末次隨訪除骨盆入射角以外的所有影像學參數(shù)對比術前均有顯著差異(p0.05)。結(jié)論依據(jù)Lenke-Silva分型為指導制定手術方案的全部退變性脊柱側(cè)凸病例均取得了滿意的臨床療效,該分型對于國人退變性脊柱側(cè)彎的臨床診療具有確切的指導意義,臨床應用可行,實用性強,可作為國人退變性脊柱側(cè)凸的臨床分型和治療決策制定的標準。
[Abstract]:Objective to evaluate and analyze the guiding role and significance of Lenke-Silva classification in the clinical application of degenerative scoliosis in Chinese. Methods 65 cases of degenerative scoliosis treated in our hospital from March 2011 to September 2014 were retrospectively analyzed in order to provide a theoretical reference for the clinical diagnosis and treatment of degenerative scoliosis. All cases were classified according to Lenke-Silva classification. There were 7 cases in grade 1, 14 cases in grade 2, 14 cases in grade 3, 15 cases in grade 4, 13 cases in grade 4, 10 cases in grade 5, 6 cases in grade 6. Grade 2 patients were treated with posterior decompression and short segment fusion fixation. Among the 3 grade cases, 3 cases were treated with short segment fusion fixation and 12 cases were treated with lateral bending correction. In 4 grade cases, 10 cases were treated with posterior decompression, fusion and fixation of kyphosis, and 3 cases with extension fixation to thoracic vertebra. In grade 5, posterior decompression, orthopedics, long segment fusion and fixation to thoracic vertebrae were performed in 9 cases, osteotomy in 1 case; All patients were treated with osteotomy and orthopedic surgery. The sagittal vertical axisus was compared before and after operation. The central sacral vertical line distance was located between the C7 lead perpendicular and the sacral midline when standing naturally. C7PL-CSVLA, Cobb angle of lumbar vertebrae, LLL (LLL). Pelvic incidence anglep, pelvic tilt anglePTT (pelvic angle of incidence). The changes of the imaging parameters of PI-LL in the matching of pelvic incidence angle with lumbar kyphosis angle; The preoperative and postoperative Oswestry dysfunction index and visual analogue scale were evaluated. Scoliosis research society-22 SRS-22 scores were compared to understand postoperative pain. Results all patients were followed up for the shortest 11 months, the longest follow-up 4 years (average 15.3 months). All patients were followed up 6 months and the last time. The scores of function and quality of life (VASA ODII SRS-22) were significantly improved compared with those before operation (P 0.05). Imaging evaluation showed that there was no significant difference in Cobb angle, lumbar kyphosis angle and pelvic parameters between preoperative and postoperative patients 6 months after operation (P 0.05). Patients with grade 3-6 were treated 6 months after operation. All the imaging parameters except the incidence angle of pelvis in the last follow-up were significantly different from those before operation (p 0.05). Conclusion all degenerative scoliosis cases with degenerative scoliosis under the guidance of Lenke-Silva classification have achieved satisfactory clinical results. This classification has definite guiding significance for the clinical diagnosis and treatment of degenerative scoliosis in Chinese. It is feasible and practical in clinical application. It can be used as the standard of clinical classification and treatment decision of degenerative scoliosis in Chinese.
【學位授予單位】：寧夏醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R682.3
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本文編號：1439030