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目的 :探讨青少年脊柱侧凸合并腰椎滑脱患者手术治疗方式的选择,观察脊柱侧凸及滑脱程度的转归。方法:对2002年5月~2011年1月收治的有完整影像学资料的9例青少年脊柱侧凸合并腰椎滑脱的患者进行回顾性分析。年龄10~18岁,平均14.4±2.7岁。功能性脊柱侧凸3例,特发性脊柱侧凸6例;发育性腰椎滑脱3例,峡部裂性腰椎滑脱6例。滑脱节段均为L5/S1,Ⅰ度滑脱4例,Ⅱ度滑脱2例,Ⅲ度滑脱2例,Ⅳ度滑脱1例。3例(1、3、4号)功能性侧凸患儿均行腰椎滑脱后路复位内固定植骨融合术。1例(2号)特发性脊柱胸腰双弯患儿侧凸Cobb角未达到手术干预标准,行单一腰椎滑脱后路复位内固定植骨融合术;2例(5、6号)无滑脱症状的特发性脊柱侧凸患儿行脊柱侧凸后路矫形内固定植骨融合术;3例(7~9号)伴腰椎滑脱症状者同时行后路滑脱复位与脊柱侧凸矫形联合手术。测量患者术前、术后、末次随访时的Cobb角及滑脱相关参数。结果:仅行单一腰椎滑脱后路复位内固定植骨融合术的4例患儿末次随访时的侧凸主弯Cobb角改善率分别为58.1%、11.5%、57.9%、36.7%,滑脱百分比改善率分别为61.3%、76.9%、59.7%、27.3%;2例仅行脊柱侧凸后路矫形内固定植骨融合术患儿的侧凸主弯Cobb角改善率分别为81.8%及68.6%,滑脱百分比改善率分别为71.8%及25.0%;3例同时行腰椎滑脱后路复位和脊柱侧凸矫形内固定植骨融合术患儿末次随访时Cobb角改善率分别为86.2%、75.6%、72.9%,滑脱百分比改善率分别为31.8%、50.0%、67.7%。7例患儿术前有不同程度的腰痛症状,1~4号患儿ODI评分为26.0(21.0~31.0)分,7~9号为23.0(15.0~29.0)分,末次随访时分别为7.0(5.0~10.0)分和6.0(5.0~8.0)分。9例患儿在术后及随访过程中均未出现并发症。结论:对青少年脊柱侧凸合并腰椎滑脱患儿应根据侧凸类型及腰椎滑脱程度选择手术方式,侧凸Cobb角大于40°伴腰椎滑脱所致腰痛症状时,应同时行脊柱侧凸矫形术和腰椎滑脱复位术;若仅满足腰椎滑脱复位内固定或者仅满足脊柱侧凸矫形的手术干预要求,可考虑行单一后路行腰椎滑脱复位内固定术或单一后路脊柱侧凸矫形手术。
Objective: To explore the selection of surgical treatment for adolescent scoliosis with spondylolisthesis and to observe the outcome of scoliosis and spondylolisthesis. Methods: Nine patients with scoliosis and lumbar spondylolisthesis admitted from May 2002 to January 2011 were retrospectively analyzed. Aged 10 to 18 years old, with an average of 14.4 ± 2.7 years. 3 cases of functional scoliosis, 6 cases of idiopathic scoliosis, 3 cases of developmental spondylolisthesis and 6 cases of isthmic spondylolisthesis. There were 4 cases of grade Ⅰ slippage, 2 cases of grade Ⅱ slippage, 2 cases of grade Ⅲ slippage, and 1 case of grade Ⅳ slippage. Three cases (1, 3, 4) functional scoliosis children underwent lumbar spondylolisthesis reduction and internal fixation fusion. The Cobb angle of 1 patient (2) with idiopathic thoracolumbar curves did not reach the standard of surgical intervention. All the patients underwent single lumbar spondylolisthesis reduction and internal fixation fusion. Two cases (No.5 and No.6) had no slippage Symptoms of idiopathic scoliosis in children with scoliosis posterior fixed orthopedic bone graft fusion; 3 cases (7-9) with symptoms of lumbar spondylolisthesis at the same time posterior slippage reduction and scoliosis orthopedic surgery . Cobb angle and slippage related parameters were measured before, during and after the last follow-up. Results: The results of Cobb angle correction in the four cases with single lumbar spondylolisthesis and posterior approach fusion fixation were 58.1%, 11.5%, 57.9% and 36.7%, respectively. The percentage of slippage was improved The rates of Cobb angle improvement were 81.8% and 68.6% in two cases of scoliosis posterior curve orthopedic arthrodesis and bony fusion, respectively. The rate of improvement was 61.3%, 76.9%, 59.7% and 27.3% respectively. The rate of improvement of Cobb’s angle at the final follow-up was 86.2%, 75.6%, 72.9% respectively in 3 children who underwent both spondylolisthesis reduction and scoliosis orthopedic fusion. %, The percentage of slippage improvement rates were 31.8%, 50.0%, 67.7% respectively. Seven patients had different degrees of low back pain before operation. The ODI scores of patients with 1 ~ 4 were 26.0 (21.0-31.0), 23.0 (15.0-29.0) at 7-9, and 7.0 ( 5.0 to 10.0) points and 6.0 (5.0 to 8.0) points. No complications occurred in 9 cases of children after operation and follow-up. Conclusion: Adolescent scoliosis combined with lumbar spondylolisthesis should be based on the type of scoliosis and degree of lumbar spondylolisthesis surgery, scoliosis Cobb angle greater than 40 ° with lumbar spondylolisthesis should be accompanied by low back pain at the same time scoliosis surgery and Lumbar spondylolisthesis reduction; if only to meet the lumbar spondylolisthesis reduction or internal fixation or only to meet the requirements of scoliosis orthopedic surgery may be considered a single posterior line lumbar spondylolisthesis or a posterior scoliosis orthopedic surgery.