POSTERIOR SELECTIVE THORACIC FUSION IN ADOLESCENT IDIOPATHIC SCOLIOSIS

Objective To define the criteria of posterior selective thoracic fusion in patients with adolescent idiopathic scoliosis.Methods By reviewing the medical records and roentgenograms of 17 patients with adolescent idiopathic scoliosis who underwent posterior selective thoracic fusion, the curve type, Cobb angle, apical vertebral rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed.Results There were 17 King type Ⅱ patients (PUMC type: Ⅱb1 13, Ⅱc3 4). The coronal Cobb angle of thoracic curve before and after operation were 56.9°and 21.6° respectively, the mean correction rate was 60.1%. The coronal Cobb angle of lumbar curve before and after operation were 34.8° and 12.1° respectively, and the mean spontaneous correction rate was 64.8%.At final follow-up, the coronal Cobb angle of thoracic and lumbar curve were 23.5° and 15.2° respectively, there were no significant changes in the coronal Cobb angle, apical vertebral translation and rotation compared with that after operation.One patient had 12° of thoracolumbar kyphosis after operation, no progression was noted at final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.9 levels were saved compared with fusing both the thoracic and lumbar curves.Conclusion Posterior selective thoracic fusion can be safely and effectively performed in King type Ⅱ patients with a moderate and flexible lumbar curve, which can save more mobile segments and at the same time can maintain a good coronal and sagittal balance.     

Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients

Background Selective anterior thoracolumbar/lumbar （TL/L） fusion and instrumentation in adolescent idiopathic scoliosis （AIS） patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients.Methods By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/Lfusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra （LIV） tilt, coronal disc angle immediately below the LIV （LIVDA） and radiographic shoulder height （RSH） were measured and analyzed.Results Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rateof 80.2% （P=0.000）. While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% （P=0.000）. At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm,which was much better than that after operation （P=0.001）. The mean LIV tilt was 23.5° before operation, and was significantly improved after operation （8.3°, P=0.000）. At final follow-up, it was well maintained （10.6°）. The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation （P=0.100） and 7.4° at final follow-up （P=0.012）,respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation （P=0.002）.Conclusions Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AlS patients, while a larger LIVDA.     

选择性前路胸腰弯/腰弯融合治疗青少年特发性脊柱侧凸

背景：自King提出对King II型特发性脊柱侧凸可进行选择性胸弯融合的概念以来,关于选择性胸弯融合后胸弯和腰弯均可获得良好矫形的报道很多。同样,对结构性胸腰弯/腰弯和非结构性胸弯患者,选择性胸腰完/腰弯融合也可获得良好的双弯矫形效果,然而这方面的报道很少。我们分析了此类青少年特发性脊柱侧凸（AIS）患者在接受选择性前路胸腰完/腰弯融合后双弯的矫正情况。 方法 回顾行选择性前路胸腰段/腰段融合的AIS病例的临床及影像学资料。测量分析Cobb角、主弯和次弯的矫形率、冠状面平衡、下融合椎倾斜度、下融合椎下位椎间角和放射学双肩高度。 结果 共40例患者,胸腰弯/腰弯冠状面Cobb角术前平均为43.9°,术后矫正为8.7°,矫正率为80.6%(P=0.000);胸弯冠状面Cobb角术前平均为27.2°,术后矫正为14.3°,自动矫正率为50.5%(P=0.000)。;末次随访时胸腰弯/腰弯和胸弯分别为13.7°和17.1°,矫形丢失平均分别为5.0°和2.9°。冠状面平衡术前、术后分别为13.2 mm和11.5 mm,随访时为5.6 mm,明显好于术后(P=0.001)。 下方融合椎（LIV）倾斜术前平均为23.5°,术后为8.3°,较术前显著改善（P＝0.000）;末次随访时保持良好,为10.6°。冠状面下方融合椎下位椎间盘开角（LIVDA）术前为3.5°,术后增加到5.5°(P=0.100),末次随访时明显加重,为7.4° (P=0.012). 手术前、后及随访时双肩高度差分别为7.3 mm、5.6 mm和2.2 mm。随访时的双肩高度差明显优于术后(P=0.002)。结论 前路选择性胸腰弯/腰弯融合与固定,双弯均可获得良好的矫形效果、冠状面平衡和双肩高度差,但下方融合椎下位椎间盘开角较大。     

ANTERIOR SPINAL FUSION WITH TSRH INSTRUMENTATION FOR SCOLIOSIS

Objective. To introduce a new spinal internal fixation system, Texas Scottish Rite Hospital (TSRH), and to investigate its early clinical outcomes.Methods. The preliminary clinical outcomes of 15 patients with thoracolumbar or lumbar scoliosis treated by anterior spinal fusion with TSRH instrumentation were studied retrospectively. Fourteen patients were diagnosed as idiopathic scoliosis and 1 as neuromuscular scoliosis.Results. Preoperatively, the Cobb's angle on the coronal plane was 55. 8° (range 35° - 78°), and 14° postoperatively, with an average correction of 74. 8 %. The average unfused thoracical curve was 35. 9 ° preoperatively (range 26° - 51°) and 21. 8° (10°-42° ) postoperatively, with 40% correction. The sagittal curve of lumbar was kept physiologically, preoperative 27. 9° and postoperative 25. 7° respectively. The trunk shift was 13.4 mm (5 - 28mm) preoperatively and 3. 5 mm (0-7 mm) postoperatively. The averaged apic vertebra derivation was 47. 8 mm (21 - 69 mm) before operat     

后路选择性融合治疗青少年特发性脊柱侧凸单胸弯

目的探讨单胸弯青少年特发性脊柱侧凸手术治疗策略及融合节段的选择。方法治疗单胸弯青少年特发性脊柱侧凸72例（Lenke IA50例,LenkeIB8例,LenkeIC14例）,平均年龄14．3岁,男13例,女59例。均采取后路选择性胸椎融合治疗。上融合椎取上位的旋转中立位椎体;下融合椎通过下端椎、下方的旋转中立椎、稳定椎之间的相互关系来确定,取中立椎、中立椎上一位椎体或稳定椎上一位椎体。术前查站立位脊柱全长前后位、侧位,卧位左右侧屈位片,术后及随访时查站立位脊椎全长前后位、侧位片。测量冠状位Cobb角、顶椎偏移、顶椎旋转、躯干偏移,来观察侧弯矫治及躯干平衡情况。平均融合7．3个节段（4～10个节段）,平均随访15．9个月（12～39个月）。结果手术前后胸弯冠状位Cobb角分别为（56．74-14．5）°（40～98°）和（18．54-8．3）°（3～40°）;手术前后腰弯冠状位Cobb角分别为（33．94-10．4）°（25～69°）和（11．14-6．4）°（0～30°）,自发矫正率为（66．94-16）％（44～100）％。躯干偏移由（16．14-10．2）mm（4—43）min矫至（8．24-6．1）mm（0～25min）,有2例病人术后出现轻度躯干失平衡,随访两年无进一步进展。结论结合站立位上下端椎、中立椎、稳定椎确定融合范围在矫治单胸弯青少年特发性脊柱侧凸中可取得良好的矫治效果。     

Comparison of the curative effects of video assisted thoracoscopic anterior correction and small incision, thoracotomic anterior correction for idiopathic thoracic scoliosis

Background The advantages of video assisted thoracoscopic anterior correction for scoliosis are minimal invasion and relatively short-time instrumentation; however the relatively steep learning curve cannot be ignored. Small incision, thoracotomic anterior correction for idiopathic thoracic scoliosis could be another choice because of less demanding technique. We compared the outcomes of these two techniques. Methods Forty-nine patients with idiopathic right thoracic scoliosis were randomly divided into two groups. Group A was 12 girls with mean age 14.9 years, mean Cobb angle 52° and Risser signs ＂＋＋＋＂ to ＂＋＋＋＋＂. Ten patients received video assisted thoracoscopic anterior correction with Eclipse rectification and two with Frontier instrumentation. Group B was 4 boys and 33 girls with mean age 14.1 years, mean Cobb angle of 56° and Risser signs ＂＋＋＂ to ＂＋＋＋＋＂. These patients underwent small incision, thoracotomic anterior instrumentation. The operation time, blood loss, postoperative drainage, instrumented levels, curve correction and early loss of correction of both groups were analyzed. Results Group A had average operation time of （390±82） minutes, intraoperative blood loss of （600±155） ml, instrumented level of 7.4±1.3, postoperative drainage of （500±160） ml, correction rate of （65±16）% and loss of correction during the 18-36 month followup of （8.6±2.9）%. Group B had average operative time of （220±80） minutes, intraoperative blood loss of （320±120） ml, instrumented level of 7.8±0.9, postoperative drainage of （210±90） ml, curve correction rate of （70±12）% and loss of correction during the 18-36-month followup of （4.6±3.9）%. The curve correction rates of the two groups were not statistically significant （P 〉0.05）. However, the operative time, blood loss, postoperative drainage, and early loss of correction showed statistical significance （P 〈0.05）. Conclusion Both video assisted thoracoscopic anterior cor     

后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形

目的 评价后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形的安全性和早期临床治疗效果.方法 回顾性分析12例行后路顶点经椎弓根截骨术治疗重度僵硬性脊柱侧后凸畸形患者的术前、术后及随访时的X光像,对侧凸Cobb角、后凸Cobb角、躯干平衡等进行测量和分析.复习手术记录和病历,记录围手术期并发症.结果 本组患者12例,男4例,女8例,平均年龄20.1(9～57)岁,其中成人脊柱侧凸2例,先天性脊柱侧后凸畸形10例.平均随访9.2个月.融合固定节段平均12个节段.手术时间平均5.0 h,术中出血量平均1517 ml,回输自体血平均780 ml,异体输血平均1109 ml.手术前后主弯冠状面Cobb角分别为100.9°和48.8°,平均矫正率51.8%(P=0.000).节段性后凸Cobb角分别为81.7°和42.2°,平均矫正率为49.8%(P=0.000).随访时主弯冠状面Cobb角及节段性后凸Cobb角分别为50.7°和46.0°,矫形无明显丢失(P=0.763,P=0.698).手术前、后及随访时冠状面躯干平衡分别为16.3、14.7和12.0mm,随访时仅1例发生冠状面躯干失平衡(22 mm).2例患者出现一过性的下肢单侧肢体麻木、无力,获完全恢复.所有患者均无脊髓损伤.结论 后路顶点经椎弓根截骨术是矫正重度僵硬性脊柱侧后凸畸形的安全方法 ,早期结果 令人满意.     

应用多层螺旋CT曲面重建技术评价特发性脊柱侧凸柔韧度

目的 探讨应用多层螺旋CT曲面重建(CPR)技术评价特发性脊柱侧凸的冠状面和矢状面,提出特发性脊柱侧凸柔韧度评价的新方法,确立侧凸脊柱卧位的冠状面和矢状面特征.方法 45例10～18岁特发性脊柱侧凸青少年女孩进行了术前多层螺旋CT脊柱扫描.采用曲面重建技术分别对脊柱进行了冠状面和矢状面的重建,测量了主弯、代偿弯的Cobb角等各项数值,并与患者X线影像结果进行了比较分析.结果 侧凸曲面重建后,冠状面主弯曲面重建(CPR)图像的Cobb角较主弯X线站立位像Cobb角平均小10.17°,冠状面代偿弯CPR的Cobb角较代偿弯X线站立位像Cobb角平均小6.97°.对于侧凸冠状面柔韧度的评价,Fulcrum像方法提供了最大的术前矫正程度.对于主胸弯组和主腰/胸腰弯组的对比没有发现,10～14岁年龄组和15～18岁年龄组间仅术后Cobb角有差别.对于手术矫形率和柔韧度,主胸弯组和主腰/胸腰弯组Bending像两组的柔韧度有差异.不同年龄组比较发现手术矫形率、主弯柔韧度和代偿弯的柔韧度两组比较,10～14岁柔韧度较大.矢状面上,主胸弯组和主腰/胸腰弯组CPR胸后凸(T5～T12)角和CPR上胸弯(T1～T5)角两组之间比较,主胸弯的胸后凸角度较小.按年龄分组中,CPR胸后凸(T5～T12)Cobb角两组之间有差异,10～14岁组的胸后凸Cobb角度较小.相关分析示CPR主弯的柔韧度、Bending像的柔韧度和手术矫形率相关.结论 AIS主弯的卧位CPR柔韧度、Bending像柔韧度和侧凸的手术矫形率呈正相关.10～14岁AIS患者矢状面胸后凸较15～18岁患者减小,主胸弯AIS患者矢状面的胸后凸和上胸弯较主腰/胸腰弯AIS患者减小.脊柱侧凸CT下曲面重建对侧凸类型的诊断和侧凸三维的分析很有帮助,可以在1次扫描后获得对侧凸三维等多方面的评价.     

特发性重度僵硬性脊柱侧凸的手术治疗

目的探讨特发性重度僵硬性脊柱侧凸的手术治疗效果。方法回顾性分析1999年6月至2003年6月手术治疗的特发性重度僵硬性脊柱侧凸。男9例,女15例,平均年龄17岁(12~20岁)。术前站立位主侧凸冠状面Cobb角平均98°(80°~117°),仰卧位反向弯曲相上柔韧性平均20·8%(5%~29·5%)。合并有矢状面畸形者15例。全部病例以北京协和医院分型原则进行手术融合。19例行前后路联合矫形术,5例行一期单纯后路矫形术。结果全部病例获随访,随访时间平均18个月(12~30个月)。术后主侧凸冠状面角58°(32°~100°),主侧凸矫正率平均为41·0%(10·9%~61·0%)。术后1例脱钩而行翻修术。1例钢丝断裂而无神经症状,给予严密观察。最后一次随访主侧凸冠状面角平均63°(31°~104°),矫正平均丢失5°(0°~10°)。无假关节形成及失代偿发生。结论与椎体截骨术相比,前路松解加后路矫形内固定术及单纯后路矫形内固定术具有危险性小、出血少、感染率低等优点,对特发性重度僵硬性脊柱侧凸来说,是一种安全有效的治疗方法。适当矫形及恢复冠状面和矢状面平衡是手术治疗的关键。     

CORRECTIVE SURGERY OF CONGENITAL SCOLIOSIS WITH TYPE II SPLIT SPINAL CORD MALFORMATION

CONGENITALspinaldeformitiesareusuallyduetovertebraldevelopmentaldisordersduringthefirst8weeksofgestation,1thisperiodalsoin volvesclosureoftheneuraltube,thuspatientswithcon genitalspinaldeformitiesmayalsohaveneuraltubedeform itiesamongstwhichsplitspinalcor…     

青少年特发性胸腰段/腰段侧凸前路与后路矫形效果的比较

目的 分析比较不同手术入路(远端融合椎均位于下端椎)对青少年特发性胸腰段/腰段侧凸矫形效果的影响.方法 回顾性分析青少年特发性胸腰段/腰段侧凸患者接受前路(单棒矫形固定融合,组A)或后路(全椎弓根螺钉矫形固定融合,组B)矫形固定融合手术术前、术后及随访时的X线片,对侧凸Cobb角、侧凸矫形率、椎间角的变化进行测量和分析.结果 组A共18例患者,组B共21例患者.胸腰弯/腰弯冠状面侧凸累及椎体节段数分别为5.0和5.4个(P=0.134),融合椎体数分别为4.7和5.4个(P=0.008).组A与组B术前、术后胸腰弯/腰弯冠状面Cobb角分别为49.2°和10.3°,43.8°和5.0°,术后较术前均得到明显改善(均P=0.000),矫形率分别为78.5%和87.8%(P=0.020).随访时冠状面Cobb角分别为21.7°和7.7°,矫形平均丢失8.3°和2.7°(P=0.001).术前、术后及随访时椎间角组A分别为3.1°、5.6°和7.3°,组B分别为2.3°、4.2°和4.4°,术后椎间角较术前增大,组A差异存在统计学意义(P=0.049),组B差异无统计学意义(P=0.050),组A与组B比较差异无统计学意义(P=0.231);随访时椎间角较术后增大,与术后相比,二组差异均无统计学意义(P=0.112,P=0.855),但组A较组B椎间角大(P=0.026).随访时近端交界性后凸的发生组间比较差异无统计学意义(P=0.235).结论 对于青少年特发性胸腰段/腰段侧凸,在远端融合椎止于下端椎时,采用后路全椎弓根螺钉矫形固定融合手术侧凸冠状面矫形率、矫形丢失、椎间角的变化优于前路手术,但融合节段长.     

SURGICAL TREATMENT OF SCOLIOSIS CAUSED BY NEUROFIBROMATOSIS TYPE 1

Objective To retrospectively analyze the relationship between curve types and clinical results in surgical treatment of scoliosis in patients with neurofibromatosis type 1 (NF-1).Methods Forty-five patients with scoliosis resulting from NF-1 were treated surgically from 1984 to 2002. Mean age at operation was 14.2 years. There were 6 nondystrophic curves and 39 dystrophic curves depended on their radiographic features. According to their apical vertebrae location, the dystrophic curves were divided into three subgroups: thoracic curve (apical vertebra at T8 or above), thoracolumbar curve (apical vertebra below T8 and above L1), and lumber curve (apical vertebra at L1 and below). Posterior spine fusion, combined anterior and posterior spine fusion were administrated based on the type and location of the curves. Mean follow-up was 6.8 years. Clinical and radiological manifestations were investigated and results were assessed.Results Three patients with muscle weakness of low extremities recovered entirely. Two patients with dystrophic lumbar curve maintained their low back pain the same as preoperatively. The mean coronal and sagittal Cobb′s angle in nondystrophic curves was 80.3° and 61.7° before operation, 30.7° and 36.9° after operation, and 32.9° and 42.1° at follow-up,respectively. In dystrophic thoracic curves, preoperative Cobb's angle in coronal and sagittal plane was 96.5° and 79.8°,postoperative 49.3°and 41.7°, follow-up 54.1° and 45.3°, respectively. In thoracolumbar curves, preoperative Cobb's angle in coronal and sagittal plane was 75.0° and 47.5°, postoperative 31.2° and 22.8°, follow-up 37.5° and 27.8°, respectively. In lumbar curves preoperative Cobb's angle in coronal plane was 55.3°, postoperative 19.3°, and follow-up 32.1 °. Six patients with dystrophic curves had his or her curve deteriorated more than 10 degrees at follow-up. Three of them were in the thoracic subgroup and their kyphosis was larger than 95 degrees, and three in lumbar subgroup. Hardware failure occurred in 3cases. Six patients had 7 revision procedures totally.Conclusions Posterior spinal fusion is effective for most dystrophic thoracic curves in patients whose kyphosis is less than 95 degrees. Combined anterior and posterior spinal fusion is stronger recommended for patients whose kyphosis is larger than 95 degrees and those whose apical vertebra is located below T8. Patients should be informed that repeated spine fusion might be necessary even after combined anterior and posterior spine fusion.     

Surgical strategy of one stage surgery of anterior release combined with posterior correction in treatment of severe scoliosis

Objective: Severe scoliosis refers to scoliosis with serious and stiff curve. It always combins with trunk imbalance in coronal and sagittal contour. Besides complex pathological changes, cardiopulmonary deficits and other concomitant diseases increase treatmental difficulties. So the treatment of severe scoliosis is always a great challenge to spine surgeon. Methods :Thirty-six patients with severe scoliosis received one stage posterior correction followed by anterior release during July 1997 to January 2003, including 9 males and 27 females. Mean age was 17.2 years. Of them, 33 was idiopathic scoliosis and 3 was neurofibromatosis scoliosis( Cobb angle: 85-116 degree); 20 cases were abnormal in sagital plane. Three-dimensional devised instrumentation were applied such as CD, CD-Horizon, TSRH or Isola in posterior procedure followed by anterior release during the same anesthesia. 31 cases of this group received thorac icplasty. Results: The correction in the frontal plane achieved an average of 48.5%. In the sagittal plane, the pathological shape of the spine was reduced and distinctly ameliorated. 80. 6% of the patients maintained or achieved balance of sagittal plane. There were no complications of severe neurological deficit, hook displacement, rod broken, and deep infection at follow-up. One case occurred traumatic pleurisy after operation and another appeared pseudarthrosis 2 years later. One case demonstrated imbalance 11 months after operation. One patient was presented loss of correction more than 10 degree at one year follow-up and 5.2 degree in average. Conclusion:The study indicates that the one stage posterior correction combined with anterior release in treatment of severe scoliosis can achieve satisfactory correction. Appropriate choice of cases, preoperational detailed assessment and application of SEP and wake-up test during operation can possibly reduce severe complication. The long-term outcomes still need further observation.     

THREE-DIMENSIONAL CORRECTION OF SCOLIOSIS USING TSRH INSTRUMENTATION

INTRODUCTION Adolescent idiopathic scoliosis is increasingly recognized as three- dimensional deformation of the spine resulting in complex displacement of the vertebrae (1,2), that is scoliosis in the coronal plane, hypokyphosis or hyperkyphosis in the sagittal plane, and rotational deformity in the axial plane.Harrington instrumentation alone can not correct the deformity in the sagittal plane efficiently, and the correction in the coronal plane will be lost with time. In some cases, the…     

改良Halo-骨盆架在儿童重度脊柱侧凸牵引治疗中的应用价值

目的探讨改良Halo-骨盆架在儿童重度僵硬性脊柱侧凸矫形前牵引治疗中的应用价值。方法2006年1月-2011年3月儿童重度僵硬性脊柱侧凸病例18例,在矫形术前用改良Halo-骨盆架进行牵引并对其临床资料进行回顾性分析。术前冠状面侧凸Cobb角82°～159°,平均118．4°,矢状面后凸Cobb角46°～116°,平均91°。最大牵引力为体重的1／3—1／2进行术前牵引。对牵引前、牵引后、矫形术后的侧后凸纠正率进行统计比较。结果平均最大牵引重量8kg,约占平均体重（14．3kg）的51．2％,牵引2～4周（平均2．3周）。6例患者在牵引2周时出现右侧臂丛神经麻痹,减少牵引力后症状消失。矫形术后无瘫痪、呼吸衰竭和死亡发生。牵引后冠状面侧凸纠正率平均39．6％;矢状面后凸纠正率平均30．7％;肺功能及动脉血气结果明显改善。矫形术后冠状面侧凸矫正率平均为49．2％;矢状面后凸矫正率平均为39．3％。结论术前用改良Halo-骨盆架牵引可明显提高儿童重度僵硬性脊柱侧凸效果并能改善患者肺功能,减少并发症。     

多孔中空椎弓根螺钉骨水泥加强固定治疗合并骨质疏松症的腰椎退变性侧凸

目的：探讨应用多孔中空椎弓根螺钉（cement injectable cannulated pedicle screws,CICPs）骨水泥加强固定治疗合并骨质疏松症的腰椎退变性侧凸的有效性和安全性。方法： 回顾性队列研究2014年10月至2015年12月期间北京大学第一医院骨科治疗腰椎退变性侧凸Lenke silva分级Ⅲ级或Ⅳ级合并骨质疏松症的手术病例,比较多孔中空椎弓根螺钉骨水泥加强固定病例和常规手术病例在腰椎退变性侧凸减压矫形固定融合手术中的临床效果和安全性。术后１个月、６个月和1年各随访一次,采用腰痛视觉模拟评分（visual analog scale, VAS）和下肢痛VAS评定临床症状改善情况,采用Oswestry功能障碍指数（Oswestry disability index, ODI）评分和欧洲五维健康量表(EuroQol 5 dimensions,EQ 5D)评定术后功能改善情况。拍摄腰椎正侧位Ｘ线片、动力位Ｘ线片和脊柱全长正侧位X线片,测定冠状位侧弯Cobb角、矢状位胸椎后凸、腰椎前凸Cobb角以及矢状位平衡距离(sagittal vertical axis, SVA), 评估手术节段的融合情况。结果： 共入组34例病例,其中CICPs组15例,对照组19例,两组病例的一般资料包括年龄、性别比例、体重、身高、体重指数、骨密度T值差异均无统计学意义;CICPs组平均骨水泥加强(5.7±2.2)枚螺钉,手术时间、术中出血量和术中输血量CICPs组高于对照组,但差异无统计学意义。临床效果评定中,两组病例术后1个月、术后6个月、术后1年腰痛VAS评分、下肢痛VAS评分、ODI评分和EQ 5D量表同术前相比均明显降低;组间比较,腰痛VAS评分术后6个月(CICPs组3.1±1.3 vs. 对照组 4.4±1.4,P<0.01）和术后1年(CICPs组3.3±1.0 vs. 对照组5.2±1.4,P<0.01）,ODI评分术后1年(CICPs组22.7±17.2 vs. 对照组31.4±18.5,P<0.01）和EQ 5D量表术后1年(CICPs组2.9±2.0 vs. 对照组3.5±2.5,P<0.01）CICPs组要低于对照组。影像学参数评定中,两组病例腰椎侧凸的冠状位Cobb角术后1个月、术后6个月、术后1年同术前相比均得到明显纠正,矢状位腰椎前凸角和胸椎后凸角术后1个月、术后6个月、术后1年同术前相比较术前均显著增加,组间比较,腰椎侧凸的冠状位Cobb角术后1年CICPs组要明显低于对照组(CICPs组17.6°±6.9° vs.对照组21.2°±7.2°,P<0.01）,腰椎前凸角术后6个月(CICPs组-33.5°±8.8° vs.对照组-28.9°±8.3°,P<0.01）和术后1年(CICPs组-33.0°±8.1° vs.对照组-26.3°±7.4°,P<0.01）,胸椎后凸角术后1年CICPs组要明显高于对照组(CICPs组26.4°±8.1 °vs.对照组22.1°±7.3°,P<0.01）。结论： 多孔中空椎弓根螺钉骨水泥加强固定治疗合并骨质疏松的腰椎退变性侧凸安全有效,短期临床效果满意。     

Application of posterior Moss-Miami transpedicular system for the treatment of adolescent idiopathic scoliosis

Objective： To determine the effectiveness of posterior Moss-Miami transpedicular system for the treatment of adolescent idiopathic scoliosis in 24 patients with a 2-year minimum follow-up. Methods： 24 patients who underwent operations between September 2002 and November 2003 were evaluated for curve correction, spinal balance, and complications. Age at surgery averaged 13.8 years （range from 10 to 20）. The spinal deformities were evaluated by Cobb method with anteroposterior and lateral bending radiographs. All patients were right thoracic curves. Posterior instrumentation （Moss-Miami transpedicular system） was used. The transpedicular screws were placed between T2 and L2. All the patients were assessed both clinically and radiographically. Follow-up averaged 2.8 years. Results： There was an average correction of 72% of the primary curve （pre-operation standing average 54 degrees （range from 40 to 67 degrees）, post-operation average 15.2 degrees （range from 2 to 27 degrees）, at last examination average 16.1 degrees （range from 2 to 30 degrees）. Infection and neurological complications were not noted. No major complications were observed. Conclusions： Frontal and sagittal thoracic curve correction of thoracic scoliosis can be satisfactorily obtained using Moss Miami transpedicular instrumentation. It seems that control of the three columns of the spine by the transpedicular screws offers sufficient apical translation and coronal realignment.     

后路手术治疗退行性腰椎侧凸性椎管狭窄

目的探讨腰椎后路减压、矫形固定、融合手术治疗症状性腰椎退变性侧凸的临床效果。方法2002年1月～2009年10月,治疗症状性退变性腰椎侧凸患者42例,平均年龄为64.3岁,腰椎侧凸Cobb角平均32°,采用腰椎后路减压,辅助椎弓根螺钉矫形固定、后外侧融合或椎间融合治疗。比较患者手术前后Cobb角,采用JOA29分法对术前和随访时的神经功能和生活能力进行评分。结果42例均得到随访,平均随访时间为49个月,所有患者均对治疗效果满意,生活质量提高,术前JOA评分平均11.6分,末次随访时平均26.1分,改善率平均为83.3%。术后平均矫正角度平均为16°,骨融合率达到100%,无神经损伤及翻修病例。结论腰椎后路减压、矫形固定、融合手术是治疗退变性腰椎侧凸的有效方法之一。     

脊柱侧凸的手术治疗(附51例报告)

本文报告我院自1982年至1988年治疗脊柱侧凸51例,男30例,女21例,平均年龄16.4岁。其中特发性41例,先天性7例,神经纤维瘤病3例。侧凸CObb角平均73.3°,后凸平均45.8°。单纯哈氏矫正术31例,术前加用颅盆环牵引或经胸前路松解或兼用二者共18例,特瓦手术1例,单纯椎板融合1例。治疗效果:全组侧凸矫正平均36.2°(范围10°～93°),平均矫正率49.7%;后凸平均矫正28.3°(范围2°～81°),平均矫正率55.8%,身高平均增高7.2cm(1～14cm),刀背畸形(21例)平均矫正2.5cm。治疗效果影响因素:与侧凸严重程度成反比;年龄越大,效果越差;与侧凸僵硬程度成反比。本文对手术治疗的适应证进行了讨论,认为还应包括发展中的儿童少年的脊柱侧凸病人和严重的成年人脊柱侧凸。本文还讨论了如何获得最大限度的畸形矫正,应重点克服侧凸僵硬度,重视术中脊髓监测、植骨范围和技术以及妥善的术后处理。     

后路半椎体切除并360°松解植骨融合内固定治疗先天性脊柱侧后凸畸形

目的 观察后路半椎体切除并360°松解植骨融合内固定治疗半椎体所致先天性脊柱侧后凸畸形的临床效果.方法 回顾性分析自2004年1月1日～2011年12月31日施行后路半椎体切除并360°松解植骨融合内固定术的24例先天性脊柱侧后凸患者的临床资料,术前侧凸Cobb角48.50°±10.32°(40°～82°),伴后凸畸形12例,后凸Cobb角27.20°±4.76°(13° ～38°).均行后路一期半椎体切除并360°松解植骨融合内固定术,术后1周及随访时复查全脊柱正侧位X线片,每3月随访1次.结果 术后侧凸Cobb角为12.90°±5.64°(5°～18°),矫正率为73.4％;12例伴后凸畸形者后凸Cobb角为8.70°±3.12°(6°～15°),矫正率为68.1％;术后随访6～36月,平均14.6个月,末次随访侧凸Cobb角为16.30°±6.23(6° ～22°),最终矫正率为66.4％,后凸Cobb角为11.30°土7.21(8°～21°),最终矫正率为58.5％;术后植骨融合部位骨痂形成良好,无感染、内固定器械断裂等并发症.结论 后路一期半椎体切除并360°松解植骨融合内固定治疗先天性脊柱侧后凸可直接去除致畸因素并起到良好的矫形效果.