后路凸凹侧双棒同步矫形在青少年特发性脊柱侧凸矫治中的应用

目的 探讨后路凸凹双侧矫形棒同步矫形技术在青少年特发性脊柱侧凸(AIS)外科矫治中的应用价值及疗效.方法 2006年2月至2008年8月采用后路凸凹侧双棒同步矫形技术治疗AIS 48例,其中男性16例,女性32例;年龄11～24岁,平均17.1岁.Lenke分型:Ⅰ型17例、Ⅱ型9例、Ⅲ型14例、Ⅳ型8例.行选择性胸弯融合27例,非选择性融合21例.观测手术前后冠状Cobb角、顶椎偏距、顶椎旋转、躯干偏移、尾端融合椎旋转、倾斜角、椎间角、矢状面平衡变化,评价侧凸矫正效果及脊柱平衡状况.结果 术后随访12～27个月,平均15.1个月.选择性融合患者末次随访胸、腰弯Cobb角平均矫正率分别为(76±11)%、(72±9)%.非选择性融合术患者末次随访胸、腰弯Cobb角平均矫正率分别为(74±15)%、(69±9)%.所有病例尾侧保留脊柱活动节段平均4.4个.1例因术中定位错误发生近端交界性后凸行翻修术.其余病例末次随访无脊柱失代偿,无假关节形成、神经损伤等并发症.结论 应用后路凸凹双侧矫形棒同步矫形治疗AIS,有助于提高矫形效果,重建和维持脊柱平衡,减少尾侧融合节段.     

前后路矫形融合术治疗胸腰段/腰段青少年特发性脊柱侧凸(PUMC Ⅰb/Ⅰc/Ⅱd1型)

目的比较前后两种入路及手术方法治疗特发性胸腰段／腰段脊柱侧凸的疗效。方法青少年特发性脊柱胸腰段／腰段侧凸（PUMC Ⅰb，Ⅰc，Ⅱd1型）患者28例，分为两组。A组16例，平均14．88岁，行前路短节段矫形融合术；B组12例，平均15．50岁，行后路、椎弓根系统矫形融合术。两组均采用第三代坚强矫形内固定器械。比较两组术前一般资料和术中情况，并通过X线参数，比较两种手术的矫形效果和躯干平衡的矫正情况。结果两组术前资料无显著差异，术后均无严重手术并发症，融合效果满意。A组手术时问、术中出血及输血量、内固定材料花费明显少于B组；A组平均融合4．25个节段，B组平均融合5．95个节段。随访时间12-47个月，A组术后冠状面矫正率是82％，随访时72％；B组术后冠状面矫正率是74％，随访时70％。矢状面矫形效果均满意，两组无显著性差异；A组术后即刻躯干偏移矫正不如B组，但随访时，两组无差异。两组在矫正顶椎旋转和顶椎偏移方面无显著差异。结论前路矫形和后路椎弓根系统矫形融合术治疗轻中度胸腰段／腰段青少年特发性脊柱侧凸，均可获得满意的矫形效果，但前路融合可缩短手术时间和减少术中出血、输血量，并能保留较多运动节段。     

全节段椎弓根螺钉后路选择性融合胸弯或腰弯后代偿弯的自发性矫形比较

目的 比较后路选择性融合胸弯或胸腰弯/腰弯矫正青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)后代偿弯的自发性矫形.方法 回顾性分析随访2年以上的双弯型AIS患者共41例(男6例,女35例),手术时平均年龄为13.8(11～16)岁,随访时间平均29(24～36)个月.北京协和医学院(Peking Union Medical College Hospital,PUMC)分型Ⅱb1型13例,Ⅱc1型5例,Ⅱc3型7例,Ⅱd1型16例.分为选择性胸弯融合(STF)组21例和选择性胸腰弯/腰弯融合组(SLF)20例.术前、术后和随访2年时摄站立位全脊柱正侧位和术前仰卧位左右弯曲像.结果 STF组和SLF组融合节段分别为(9.1±0.9)个和(5.5±0.7)个;术前和术后随访2年以上躯干偏移(TS)在STF组分别为(14.8±7.8)mm和(11.4±5.9)mm(P=0.048);SLF组为(24.7±7.3)mm和(13.2±4.9)am(P＜0.001);STF组代偿性腰弯由37.7°±6.8°自发矫形为15.1°±8.4°(P=0.001);SLF组代偿性胸弯由27.4°±6.7°自发矫形为14.9°±5.0°(P＜0.001).术前和术后2年在STF组中胸后凸由18.0°±6.8°降至13.5°±7.6°(P＜0.01),腰前凸由37.9°±8.4°增至43.8°±6.8°(P＜0.05);SLF组中胸后凸由12.8°±7.8°增至28.4°±10.8°(P＜0.001),腰前凸由33.4°±8.8°增至39.6°±6.9°(P＜0.05).两组术前与术后即刻、术后2年腰弯Lenke分型差异有统计学意义(P＜0.001).结论 后路全节段椎弓根螺钉系统选择性融合胸弯或胸腰弯/腰弯矫正AIS代偿弯在冠状面、矢状面上自发性矫形程度不同,腰弯Lenke分型在两组中变化明显.     

合并胸腰段后凸的青少年特发性脊柱侧凸的临床研究

目的 探讨合并胸腰段后凸的青少年特发性脊柱侧凸(AIS)的临床特点和手术治疗策略. 方法对2001年1月至2007年1月收治的413例AIS患者进行回顾性分析,合并胸腰段后凸者共10例,其中男2例,女8例;年龄12～18岁,平均14.3岁.侧凸类型包括PUMC Ⅱb2型3例,Ⅱc 3型4例,Ⅱd2型1例,Ⅲb型2例.单纯后路内固定术8例,前路松解+后路内固定术2例.术前、术后及随访时摄X线片,对侧凸类型、Cobb角、顶椎旋转度、顶椎偏距、侧凸柔韧性、胸腰段后凸、冠状面及矢状面躯干偏移进行评测和分析.结果 本组患者中双弯8例,三弯2例;胸腰弯/腰弯Cobb角≥45°者7例,柔韧性指数≤70%者6例,顶椎旋转度≥Ⅱ度者9例.所有病例的融合范围均符合PUMC分型原则.手术前后平均胸弯冠状面Cobb角分别为71.7°和37.4°,平均矫正率为47.8%;手术前后平均胸腰弯/腰弯冠状面Cobb角分别为65.0°和27.8°,平均矫正率为57.2%;手术前后平均胸腰段后凸分别为35.5°和4.2°,平均矫正率为88.2%.全部病例随访12～72个月,平均23.1个月;最终随访时无躯干失平衡发生. 结论 合并胸腰段后凸的AIS一般多为双弯或三弯,胸腰弯/腰弯畸形往往比较严重,并有明显的旋转畸形.对合并胸腰段后凸的AIS,应融合胸腰弯/腰弯以防止术后发生失代偿或后凸加重, PUMC分型可以有效识别病变类型并指导融合范围的选择.     

选择性前路和后路手术治疗胸腰段或腰段脊柱侧凸的疗效分析

目的 比较选择性前路和后路手术治疗胸腰段或腰段青少年特发性脊柱侧凸的疗效.方法 1998年3月～2004年9月,共64例胸腰段或腰段特发性脊柱侧凸患者接受手术,其中36例采用选择性前路手术(A组),28例采用选择性后路手术(B组),随访时间为2～4 年.结果 A组术前胸腰段或腰段弯曲角度平均 42°,术后平均 18°;B组术前平均46°,术后平均18°.2 组患者术后弯曲都得到了明显改善,且2组患者改善率差异无统计学意义(P>0.05),术中的出血量差异也无统计学意义(P>0.05),而B组手术时间(179 min) 相似文献   

Ⅰ期前路与后路病灶清除内固定治疗胸腰段结核的疗效比较

目的:比较前路与后路手术治疗胸腰段脊柱结核的临床疗效。方法:对2005年1月至2014年12月手术治疗的97例胸腰段脊柱结核患者回顾性分析,其中男59例,女38例;年龄20~68岁,平均53.7岁;病程1~13个月,平均(6.9±2.3)个月;采用后路手术治疗54例(后路组),前路手术治疗43例(前路组)。观察两组患者的相关指标,包括手术时间、术中及术后出血量、术后住院时间及并发症、VAS评分、ODI评分、神经功能Frankel分级、骨融合时间及Cobb角矫正率。结果:后路组手术时间(174.4±9.9)min、术中出血量(885.0±95.7)ml、术后出血量(103.2±11.5)ml、术后住院时间(15.1±0.7)d;前路组手术时间(229.5±15.2)min、术中出血量(1 326.0±113.5)ml、术后出血量(153.2±16.7)ml、术后住院时间(19.0±0.8)d,两组间的差异均具有统计学意义。并发症发生率前路组为16.3%,后路组为9.3%,差异有统计学意义。后路组的Cobb角矫正率为(73.4±3.2)%,优于前路组的(62.3±2.5)%。两组间的植骨融合时间差异无统计学意义。术后VAS、ODI评分及神经功能分级均较术前明显改善,但两组比较差异无统计学意义。结论:Ⅰ期前路或后路手术均能有效治疗胸腰段脊柱结核,但是后路手术相对于前路手术,创伤更小,畸形矫正效果更好。     

前后路内固定手术治疗胸腰段脊柱结核的对比研究

目的探讨胸腰段脊柱结核理想的手术治疗方案。方法回顾总结2000年1月~2005年6月期间行病灶清除植骨融合内固定术的胸腰段脊柱结核患者51例。所有病例分为:A组(24例)一期前路病灶清除植骨融合钉-板(棒)矫形内固定术治疗组,B组(27例)一期后路钉-棒矫形内固定前路病灶清除植骨融合术治疗组;每个组又分为累及单个椎体组(A1,B1)及累及多个椎体组(A2,B2)。分别对比研究A1、B1及A2、B2手术时间、术中出血量、矫形率、神经功能恢复情况、植骨融合时间、并发症等。结果A1组手术时间、术中出血量明显低于B1;B2组矫形率、稳定性及并发症发生率优于A2组。结论胸腰段脊柱结核累及单个椎体时一期前路病灶清除植骨融合钉-板(棒)矫形内固定术是较佳的选择;累及多个椎体尤其脊柱后凸角度偏大时一期后路钉-棒矫形内固定前路病灶清除植骨融合术更为理想。     

后路选择性胸腰弯或腰弯融合治疗Lenke 5C型青少年特发性脊柱侧凸

目的:评价后路选择性胸腰弯或腰弯融合治疗青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的临床效果。方法:回顾性分析45例行后路选择性胸腰弯(20例)或腰弯(25例)融合的Lenke 5C型AIS病例,男4例,女41例,平均年龄14.9±2.1岁(12~20岁)。所有病例均行后路椎弓根螺钉内固定矫形融合,平均随访36±20个月(24~105个月)。术前、术后及末次随访时均摄站立位全脊柱正侧位X线片,对躯干偏移、融合节段邻近椎间盘开角、远端融合椎的倾斜、冠状面和矢状面Cobb角进行测量分析。测量数据使用SPSS 17.0统计学软件进行分析。结果:术前胸腰弯或腰弯Cobb角平均47.3°±7.2°,术后矫正至6.4°±4.6°,矫正率(84.8±11.6)%,末次随访时为9.1°±5.4°,矫形丢失2.7°±4.6°。胸弯术前25.7°±7.4°,凸侧Bending像Cobb角7.6°±5.8°,柔韧性(72.7±23.0)%,术后矫正至13.2°±6.7°,自动矫正率(48.5±29.4)%,末次随访14.2°±7.6°,矫形丢失1°±6°。躯干偏移:术前21.3±11.5mm,术后19.5±13.3mm,末次随访10.9±8.9mm。术后近端与远端融合椎邻近椎间盘开角较术后明显减小,且在随访过程中无明显加重。远端融合椎倾斜术后及末次随访时均显著改善。末次随访时,交界性后凸1例,躯干失衡3例,胸弯失代偿并行融合延长手术1例。所有病例末次随访时均未见假关节形成。结论:后路选择性胸腰弯或腰弯融合对Lenke 5C型特发性脊柱侧凸可获得满意矫形效果,胸弯可获得良好的自动矫正,有效缩短了融合节段。     

胸腰段特发性脊柱侧凸的前路矫正术

目的评价胸腰段/腰段特发性脊柱侧凸经前路矫正术的临床效果。方法1998年1月~2004年1月,76例胸腰段/腰段特发性脊柱侧凸患者接受前路选择性矫正融合术。患者共76例,男19例,女57例,平均年龄为16.2岁(13~27岁)。按照Lenke分型,Ⅴ型41例,Ⅵ型35例。其中Lenke Ⅴ型术前胸腰段侧凸Cobb角平均51.3°(38°~65°),胸段侧凸Cobb角平均35.5°(23°~41°);Lenke Ⅵ型术前胸腰段侧凸Cobb角平均53.4°(46°~68°),胸段侧凸Cobb角平均39.2°(27°~51°)。所有患者均接受侧前路矫正选择性胸腰段融合。术后以及随访中对胸腰段侧凸矫正以及胸段代偿矫正情况进行分析对比,同时采用SRS-22评分评价患者手术前后的功能状况。结果患者均安全完成手术,无严重并发症发生。所有患者均随访2年以上(2~5年)。Lenke Ⅴ型组术后胸腰段侧凸Cobb角平均11.2°(3°~15°),胸段侧凸Cobb角平均8.3°(2°~11°),最终随访时分别为13.2°(5°~17°)和10.1°(4°~15°),无躯干冠状面失代偿发生;LenkeⅥ型组术后Cobb角平均16.3°(8°~21°),胸段侧凸Cobb角平均13.7°(11°~19°),最终随访时分别为17.5°(11°~24°)和15.2°(14°~21°);仅1例发生躯干冠状面失代偿,但不需要进一步治疗。两组之间无统计学差异。所有患者均在术后以及最终随访时填写了SRS-22评分表,结果显示两组患者均对治疗结果表示满意。结论胸腰段/腰段特发性脊柱侧凸经前路矫正、选择性融合可以获得良好矫正,术后胸段弯曲能够获得较好的代偿矫正,并在远期随访中维持矫正效果和躯干冠状面的平衡。     

胸腰段或腰段特发性脊柱侧凸选择性后路融合术后未融合节段在冠状面平衡重建中的作用

 目的 探讨胸腰段或腰段特发性脊柱侧凸选择性腰弯融合术后冠状面躯干偏移的重建与未融合节段的关系。方法 回顾性分析2005年10月至2011年10月行后路选择性融合术并有至少2年完整随访资料的胸腰段或腰段特发性脊柱侧凸患者的影像学资料。测量患者术前、术后及末次随访时的全脊柱正、侧位X线片。观察术后至末次随访期间患者冠状面躯干偏移的变化,并对其与上胸弯、主胸弯、腰弯、远端未融合节段和骶骨倾斜角变化的关系进行多元线性回归分析。结果 共37例患者纳入回顾性分析,男4例,女33例;年龄12～20岁,平均（14.6±2.0）岁;随访时间为2～8.9年,平均3.6年。术前患者腰弯Cobb角平均为44.2°,末次随访时为10.3°,最终矫形率为75.7%;术前主胸弯Cobb角平均为25.2°,末次随访时为13.6°,最终矫形率为44.9%;术前躯干偏移平均为2.2 cm,术后矫正为2.0 cm,术前与术后比较无明显差异,末次随访时躯干偏移自发代偿至0.9 cm,术后与末次随访时比较差异有统计学意义。回归分析发现术后患者躯干偏移的变化仅与远端未融合节段角度的改变呈线性相关,回归方程：躯干偏移变化量（cm）=1.248 7+0.137 8×远端未融合节段Cobb角变化值（°）。结论 胸腰段或腰段特发性脊柱侧凸选择性后路腰弯矫形术后,冠状面躯干平衡的重建主要由远端未融合节段来代偿;尽管手术保留了大部分胸椎节段,但其在躯干偏移的代偿中并未发挥主要作用。     

Thoracoscopic spinal fusion compared with posterior spinal fusion for the treatment of thoracic adolescent idiopathic scoliosis

BACKGROUND: Posterior spinal fusion with segmental instrumentation is the gold standard for the surgical treatment of thoracic adolescent idiopathic scoliosis. More recently, anterior surgery and video-assisted thoracoscopic surgery with spinal instrumentation have become available. The purpose of the present study was to compare the radiographic and clinical outcomes as well as pulmonary function in patients managed with either anterior thoracoscopic or posterior surgery. METHODS: Radiographic data, Scoliosis Research Society patient-based outcome questionnaires, pulmonary function, and operative records were reviewed for fifty-one patients undergoing surgical treatment of scoliosis. Data were collected preoperatively, immediately postoperatively, and at the time of the final follow-up. The radiographic parameters that were analyzed included coronal curve correction, the most caudad instrumented vertebra tilt angle correction, coronal balance, and thoracic kyphosis. The operative parameters that were evaluated included the operative time, the estimated blood loss, the blood transfusion rate, the number of levels fused, the type of bone graft used, and the number of intraoperative and postoperative complications. The pulmonary function parameters that were analyzed included vital capacity and peak flow. RESULTS: The thoracoscopic group included twenty-eight patients with a mean age of 14.6 years, and the posterior fusion group included twenty-three patients with a mean age of 14.3 years. The percent correction was 54.5% for the thoracoscopic group and 55.3% for the posterior group. With the numbers available, there were no significant differences between the two groups in terms of kyphosis (p = 0.84), coronal balance (p = 0.70), or tilt angle (p = 0.91) at the time of the final follow-up. The mean number of levels fused was 5.8 in the thoracoscopic group, compared with 9.3 levels in the posterior group (p < 0.0001). The estimated blood loss in the thoracoscopic group was significantly less than that in the posterior fusion group (361 mL compared with 545 mL; p = 0.03), and the transfusion rate in the thoracoscopic group was significantly lower than that in the posterior fusion group (14% compared with 43%; p = 0.01). Operative time in the thoracoscopic group was significantly greater than that in the posterior group (6.0 compared with 3.3 hours, p < 0.0001). There were no intraoperative complications in either group. Vital capacity and peak flow had returned to baseline levels in both groups at the time of the final follow-up. Patients in the thoracoscopic group scored higher than those in the posterior group in terms of the total score (p < 0.0001) and all of the domains (p < 0.01) of the Scoliosis Research Society questionnaire at the time of the final follow-up. CONCLUSIONS: Thoracoscopic spinal instrumentation compares favorably with posterior fusion in terms of coronal plane curve correction and balance, sagittal contour, the rate of complications, pulmonary function, and patient-based outcomes. The advantages of the procedure include the need for fewer levels of spinal fusion, less operative blood loss, lower transfusion requirements, and improved cosmesis as a result of small, well-hidden incisions. However, the operative time for the thoracoscopic procedure was nearly twice that for the posterior approach. Additional study is needed to determine the precise role of thoracoscopic spinal instrumentation in the treatment of thoracic adolescent idiopathic scoliosis.     

Ponte截骨与SPO截骨联合后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的疗效比较

[目的]对Ponte截骨与Smith-Petersen截骨(SPO截骨)治疗僵硬性青少年特发性胸椎侧凸的临床疗效及影像学结果进行回顾性比较。[方法]2007年5月～2009年3间收治的单纯后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的手术病例58例,其中36例行SPO截骨,22例行Ponte截骨。通过影像学检查对两组的手术效果和躯干平衡情况进行分析,末次随访时用中文版SRS-22量表进行患者的健康生存质量评价。[结果]两组患者的性别比例、手术时年龄、Risser征、融合节段数、置钉密度、术前冠状面胸主弯Cobb角无显著性意义(P>0.05)。Ponte截骨组的术后3个月冠状面胸主弯Cobb角矫正率明显大于SPO截骨组,分别为67.1%和56%(P<0.05)。末次随访时两组矫正率得到很好的维持,分别为61%和50.5%(P<0.05)。两组的术前、术后腰椎代偿性次弯Cobb角无显著性差异。两组的术前胸椎后凸Cobb角分别为20.6±8.5°和22.3±10.5°,术后3个月胸椎后凸角SPO截骨组比术前平均增加1.2°,Ponte截骨组比术前平均丢失1.4°,末次随访SPO截骨组胸椎后凸角比术前平均增加1.9°,Pon-te截骨组比术前平均丢失2.9°,两组间比较无显著性差异(P>0.05)。两组的次要并发症无显著性差异(P>0.05),两组均未发生主要并发症。[结论]多节段Ponte截骨能提高僵硬性青少年特发性胸椎侧凸冠状面胸主弯Cobb角的手术矫正率,并不增加并发症的发生率,而且能提供更多的局部自体植骨量、增加植骨融合面积。     

Posterior-only surgery with strong halo-femoral traction for the treatment of adolescent idiopathic scoliotic curves more than 100��

The aim of this study was to investigate the feasibility and clinical efficacy of treatment of adolescent idiopathic scoliosis of >100° via posterior-only surgery with strong halo-femoral traction and posterior wide release. From December 2003 to August 2006, 121 patients with adolescent idiopathic scoliosis were treated in our hospital; among them, 29 patients with curves over 100° were included in this study. From December 2003 to June 2005, group A included the first 12 patients who underwent combined anterior release followed by two-week halo-femoral traction and then posterior instrumentation. From July 2005 to August 2006, 17 patients in group B underwent posterior surgery alone with strong halo-femoral traction and posterior wide release. All of the patients were followed-up for a minimum of 31 months (mean, 36 months; range, 31–41 months). There were no severe complications. All of the patients achieved bony fusion without instrumentation breakage or pseudarthrosis. There were no statistically significant differences between the two groups in gender, age, type of adolescent idiopathic scoliosis, preoperative coronal major curve values, major curve flexibility, or final follow-up major curve correction rate. The average operative time, blood loss and hospital stay in group B were less than those in group A. In adolescent idiopathic scoliosis with Cobb >100°, posterior-only surgery with strong halo-femoral traction and posterior wide release can provide comparable curve correction with shorter operative time, less blood loss and shorter hospital stay when compared to combined anteroposterior surgery.     

Anterior lumbar instrumentation improves correction of severe lumbar Lenke C curves in double major idiopathic scoliosis

Fifteen skeletally immature patients with double major adolescent idiopathic scoliosis with large lumbar curves and notable L4 and L5 coronal plane obliquity were retrospectively studied. Seven patients who underwent anterior release and fusion of the lumbar curve with segmental anterior instrumentation and subsequent posterior instrumentation ending at L3 were compared with eight patients treated with anterior release and fusion without anterior instrumentation followed by posterior instrumentation to L3 or L4. At 4.5 years follow-up (range 2.5-7 years), curve correction, coronal balance and fusion rate were not statistically different between the two groups; however, the group with anterior instrumentation had improved coronal plane, near normalangulation in the distal unfused segment compared with the group without anterior instrumentation. In cases involving severe lumbar curvatures in the context of double major scoliosis, when as a first stage anterior release is chosen, the addition of instrumentation appears to restore normal coronal alignment of the distal unfused lumbar segment, and may in certain cases save a level compared with traditional fusions to L4.     

术前大质量Halo-股骨髁上牵引在治疗僵硬型特发性脊柱侧凸中的应用

目的 探讨术前快速大质量Halo-股骨髁上牵引在治疗僵硬型特发性脊柱侧凸中的应用价值.方法 对2003年7月至2006年5月行术前快速大质量Halo-股骨髁上牵引治疗且临床资料完整的16例僵硬型特发性脊柱侧凸患者进行回顾性分析.其中男性4例,女性12例;年龄12～20岁,平均16岁,术前冠状面Cobb角平均111°,胸椎后凸(T_(5～12))平均64°.术前行Halo-双侧股骨髁上牵引,最大质量(可达体质量的1/2)牵引2～3周后,行后路矫形内固定融合术.对术前Bending像、牵引后和术后侧凸纠正率进行比较.结果 随访12～60个月(平均36个月).最大牵引质量平均19 kg,为体质量的35%～56%.1例患者在牵引12 d后出现右侧臂丛神经麻痹,减轻牵引质量后逐渐恢复.矫形术后无瘫痪、死亡等并发症,无呼吸衰竭的发生.术前平卧位Bending像X线片的侧凸纠正率平均18.7%,Halo-股骨髁上牵引后侧凸纠正率平均达31.9%.与Bending像相比,牵引后侧凸纠正率提高了13.2%,差异具有统计学意义(P<0.05).后路矫形术后侧凸矫正率平均为48.6%,胸椎后凸矫正率平均为51.9%.末次随访时冠状面矫正丢失率平均为2.0%,矢状面矫正丢失率平均为5.8%.结论 术前短时间大质量Halo-股骨髁上牵引结合后路广泛松解可改善僵硬型特发性脊柱侧凸畸形矫形率,但应注意与牵引相关的并发症.     

Anterior versus posterior fusion surgery in idiopathic scoliosis: a comparison of health-related quality of life and radiographic outcomes in Lenke 5C curves - results from the Swedish spine registry

PurposeTo compare health-related quality of life and radiographic outcomes in patients treated with either anterior or posterior fusion surgery for Lenke 5C type idiopathic scoliosis.MethodsWe used data from the Swedish spine registry and identified 59 patients with idiopathic scoliosis treated with fusion for Lenke 5C type curves; 27 patients underwent anterior surgery and 32 underwent posterior surgery. All patients had pre- and postoperative radiographic data and postoperative clinical data at a minimum of two years after surgery. Patient-reported outcomes measures included the Scoliosis Research Society (SRS)-22r, EuroQoL 5 dimensions 3 levels (EQ-5D-3L), EQ-visual analogue scale (VAS) and VAS for back pain. Radiographic assessment included measurement of the angle of the major curve, disc angulation below the lowest instrumented vertebra, curve flexibility, rate of curve correction, differences in sagittal parameters, number of fused vertebrae and length of fusion.ResultsThe mean age at surgery was 16 years in both groups. The mean follow-up time was 3.8 years. There were no significant differences in the SRS-22r score and EQ-5D-3L index at follow-up (all p ≥ 0.2). Postoperatively, both the anterior and posterior fusion group demonstrated a significant correction of the major curve (p ≤ 0.001) with no significant difference of the correction rate between the groups (p = 0.4). The posterior fusion group had shorter operative time (p < 0.001) and higher perioperative blood loss (p = 0.004) while the anterior group had lower number of fused vertebrae ( p< 0.001).ConclusionThe type of surgical approach for Lenke 5C curves is not associated with differences in health-related quality of life, despite the lower number of fused vertebrae after anterior surgery.Level of EvidenceIII     

前路和后路手术治疗胸腰段特发性脊柱侧凸的临床研究

目的：对照性研究前路和后路手术治疗青少年胸腰段特发性脊柱侧凸的手术效果。方法：按照同一标准,从1998年1月～2006年1月手术治疗的231例青少年特发性脊柱侧凸中选出胸腰段脊柱侧凸61例。A组前路手术,28例。B组后路手术,33例。结果：随访2～6年（平均3．5年）。手术时间A组4．5h±0．8h,B组3．1h±1．0h（P〈0．01）。出血量A组1400ml±350ml,B组1100ml±230ml（P〈0．05）。术后引流量A组380m1±190ml,B组250ml±150ml（P〈0．05）。固定节段A组4．5±0．6个椎体,B组7．1±1．2个椎体（P〈0．01）。平均矫正率A组75％,B组74％（JD〉0．05）。剃刀背矫正度A组3．8°±2．4°,B组4．1°±2．6°（P〉0．05）。2年后矫正度甲均丢失A组4．3°±1．4°,B组5．4°±2．1°（p〉0．05）。随访2年尢假关节及内固定失败病例。术后交界性后凸角B组发生率高（P〈0．01）。结论：畸形的矫正、剃刀背的改善、矫正度的丢失前路和后路相当。后路手术有损伤小、出血少,术后引流量少。后路手术容易产生PJK。