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.     

Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis

Background  Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves in patient with adolescent idiopathic scoliosis (AIS). But the anterior operations often induce severe complications. Some surgeons choose posterior-only surgery with halo-femoral traction, posterior wide release and correction. But to the best of our knowledge, there are only rare prospective studies on these posterior-only surgeries for AIS patients who have a rigid curve more than 80° and flexibility less than 35%.

Methods  Sixty-four AIS patients were recruited from September 2006 to June 2009. All patients had rigid curves and underwent spinal correction. They were randomly divided into group A (combined anteroposterior surgery) and group B (posterior-only surgery). Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed pre- and post-operation and during follow-up visits. The operation time, blood loss, hospital days, and hospital charges were compared between the two groups.

Results  These patients were followed for an average of 37.5 months (range, 24–65 months). No serious complications were observed. There were no significant differences between the two groups in gender, age, preoperative radiographic data, or preoperative SRS-22 score. The average operation time, blood loss, hospital days and hospital charges in group B were less than those in group A. The SRS-22 score in group B was better than in group A at post-operation and at final follow-up.

Conclusions  In AIS with a rigid curve more than 80° and flexibility less than 35%, strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores, comparable curve correction, shorter operation time, less blood loss, shorter hospital stays and lower charges when compared to combined anterior and posterior surgery.

     

VIDEO-ASSISTED THORACOSCOPIC CORRECTION AND FUSION OF SCOLIOSIS

Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marfan syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. Results The mean operation time was 6.4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mL. The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4° to 11.8°, with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final follow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0° and 20.1°, with a 3.6° and 8.3° loss of correction, respectively. The apical vertebral translation was improved from 32.3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-operative complications, including 1 case of thoracic effusion, 1 case of chylothorax, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve (1 case also with thoracolumbar kyphosis), and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery. Conclusions Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of correction loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique.     

Surgical treatment for scoliosis extending to main thoracic spine by keyvertebral-screws technique （KVST）

Objective ：To introduce a key-vertebral-screws technique （KVST） in the surgical treatment of scoliosis extending to main thoracic levels, and to find the role of fulcrum bending in predicting the result of surgical treatment for scoliosis by this technique. Methods： Seventeen consecutive patients with scoliosis extending to main thoracic spine, who underwent pure posterior fusion without anterior or posterior release by KVST between January 2004 and July 2005 were evaluated for fulcrum bending flexibility, surgical correction rate, fulcrum bending correction index （FBCI） in main thoracic curves. Universal Spine System （USS） instrumentation was used in 15 cases, Monarch in another 2 cases. The severity of the curves was measured by Cobb＇s method using RadWork 6.0 software. Preoperative standing AP radiographs, preoperative fulcrum bending anterioposterior （AP） radiographs, postoperative standing AP radiographs, and most recent follow-up standing AP radiographs for spine were measured and recorded. All the data were analyzed with two-sample paired t-test by Origin 7.0 software. Results： Infection and neurological complications were not noted. No major complications were found. Just one case had some axial back pain, which got a full recovery from physiotherapy for 2 weeks. In the X-ray, there was an average correction of 71.5 % of the fused main thoracic curves, which had no significant lose of correction in final follow-up. For the whole fused main thoracic curves, the fulcrum bending flexibility were lower to operation correction rate （P=0. 013）. The average FBCI was 123%. From the data, the more rigid curves （especially fulcrum bending flexibility 〈50%）, the more correction rate operation could get, compared with fulcrum bending flexibility. Conclusion： （1） KVST is a good method in the surgical treatment of thoracic scoliosis, which can get satisfying result with lower medical cost. （2） Fulcrum bending flexibility is lower than operative correction rate by KVST in main     

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.     

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。     

Surgical treatment of severe scoliosis and kyphoscoliosis by stages

Background  Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis, two-stage surgery strategy (less invasive internal distraction followed by posterior correction and instrumentation) has never been reported in the treatment of patients with severe spinal deformity. This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.

Methods  A total of 15 patients with severe scoliosis, kyphoscoliosis or kyphosis who underwent two-stage surgeries (less invasive internal distraction followed by posterior correction and instrumentation) were studied based on hospital records. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.

Results  The average major curve magnitude was 129.4° (range, 95° to 175°), reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery. The loss of correction during the interval between two surgeries was 7.1%. The total major coronal curve correction was 81.4°or 62.9%. At the final follow up, the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%. The average major sagittal curve magnitude was 80.3° (range, 30° to 170°), and the total major sagittal curve correction was 48.2°. Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 42.2°. Clinical complications were noted in the peri-operative and long-term periods.

Conclusions  Two-stage surgery was a safe and effective surgical strategy in this difficult population. Using two-small-incision technique, the first stage surgery was less invasive. No permanent neurologic deficit was noted in this series.

     

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

CONGENITALspinaldeformitiesareusuallyduetovertebraldevelopmentaldisordersduringthefirst8weeksofgestation,1thisperiodalsoin volvesclosureoftheneuraltube,thuspatientswithcon genitalspinaldeformitiesmayalsohaveneuraltubedeform itiesamongstwhichsplitspinalcor…     

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.     

后路有限减压、固定、融合治疗退行性腰椎侧凸合并椎管狭窄症

目的：评价后路有限减压、固定、融合手术治疗退行性腰椎侧凸合并椎管狭窄症的疗效。方法：回顾性分析我院2004年12月～2010年12月收治退行性腰椎侧凸合并椎管狭窄症患者36例的临床资料,所有患者均采用后路有限减压、固定、融合手术进行治疗。采用症状视觉模拟评估量表（VAS）、医学结局研究简化量表-36（SF-36）评分系统进行疗效评估。结果：手术时间（115±24）min,出血量（550±235）ml。所有患者均获得随访,随访时间平均（2.4±0.9）年。术前患者平均Cobb角（24.3±10.4）°,腰椎前凸角（22.7±11.3）°,矢状面轴向垂线（SVA）（7.8±6.6）cm,骶正中线（CSVL）（7.0±5.9）cm,患者术后、末次随访平均Cobb角（10.6±8.5）°、（8.9±5.3）°,腰椎前凸角（25.6±14.3）°、（31.8±13.4）,SVA（0.5＋3.4）、（-1.2±2.7）cm,CSVL（2.9±1.4）、（1.7±1.2）cm,较术前差异均具有统计学意义（均P〈0.05）。术后仅1例患者发生矫正丢失,无一例发生椎间隙塌陷、神经损伤、钉棒断裂等并发症。结论：后路有限减压、固定、融合手术是治疗退行性腰椎侧凸合并椎管狭窄症的有效手段。     

中华多用脊柱内固定装置的研制及在脊柱外科中的应用

目的 报道本院研制的中华多用脊柱内固定装置应用于脊柱外科的原理及早期结果。方法 随诊为1998年9月到2000年6月期间用本装置治疗脊柱侧弯70例（男性19例,女性51例）,平均年龄14.8岁（3-34岁）,其中先天性侧弯30例,特发性侧弯36例,其它4例,此外,还随诊用本装置矫治后凸畸形16例,脊柱侧弯前路去旋转融合5例,所有病例均进行手术前后临床及X线片检查分析。结果 脊柱侧弯病例平均随诊8.9个月。侧弯Cobb角由术前平均70.5度（40-103度）矫正至平均32.5度,平均矫正率55.6%,身高平均增加6.5cm,矫正范围内的脊柱增长5mm。由本院首次治疗的22例特发性脊柱侧弯。平均矫正率73%。最好者达87.2%。后凸畸形病例平均随诊5.3个月,后凸由术前平均80.5度（40-103度）矫正至平均31.8度,矫正率50%。结论 中华多用脊柱内固定装置是矫治脊柱侧弯,尤其是生长发育中儿童侧弯的较理想的新7方法,不需植骨融合,能允许矫正范围内脊柱节段继续生长。合并症较少,本装置还可广泛用于治疗脊柱后凸,前路去旋转融合,脊柱滑脱和脊柱骨折等。     

重度脊柱侧凸或后凸畸形的分期手术治疗

背景：重度脊柱侧凸或后凸畸形一直是临床治疗难点。有报道采用临时内固定撑开棒可以帮助矫形,但采用分期手术策略治疗重度侧凸特别是后凸畸形尚未有报道。 方法：15例重度脊柱侧凸或后凸或侧后凸畸形病例接受分期手术治疗,即一期后路小切口撑开部分矫形,3～6个月后再次手术行后路松解矫形内固定植骨融合术,随访2年以上。对所有病例术前、一次术后、二次术前、二次术后和末次随访的影像学资料进行测量,分析术前主弯弹性指数以及侧凸主弯、后凸主弯在各次手术前后的变化和终末随访的丢失情况。记录围手术期并发症发生情况。 结果： 术前侧凸主弯95°～175°,平均为 129.4°,一次手术矫正 58.9°,矫形率45.4%,二次手术矫正30.6°,矫形率24.6% 。间隔期矫形丢失率 7.1%,总矫形率62.9%,随访2年矫形平均丢失率3.9°,最终总矫形率 59.7%. 术前后凸30°～170°,平均为80.3°,总矫形42.2°。 所有病例顺利完成,无严重并发症发生。 结论：后路小切口创伤小,术后恢复快,提高了二次手术耐受力和矫形率。分期手术策略矫形治疗重度脊柱侧凸或后凸畸形效果好,安全性高。     

特发性脊柱侧弯患者肩平衡的研究进展

特发性脊柱侧弯是脊柱畸形中最常见的一种。脊柱畸形导致患者躯干失衡,也会造成双肩的失衡。已经有许多影像学指标和外观指标用以评价患者术前术后肩平衡,但是并没有一项指标能够真实反映患者肩平衡,且影像学指标和外观指标间的相关性并不高。同时,手术中对于固定节段的选择尤其是术中融合上胸弯,也会对术后肩平衡产生影响。该文针对特发性脊柱侧弯患者肩平衡的最新研究进展进行综述。     

椎弓根螺钉固定三维矫治特发性脊柱侧凸的疗效

目的探讨椎弓根螺钉固定在特发性脊柱侧凸矫形术中的治疗效果。方法自2002年7月至2005年12月,对48例特发性脊柱侧凸患者行脊柱侧凸矫形术,术中采用徒手技术置入椎弓根螺钉行侧凸矫形,术后佩戴胸腰支具3个月。结果随访6～30个月,平均15个月。切口均获得Ⅰ期愈合。患者术前Cobb角平均为63.6°,术后Cobb角为20.5°,畸形矫正率为66.4%,随访中角度丢失平均为2.8°,身高平均增加约5cm。所有病例术中术后均无脊髓神经根损伤表现,均获得满意的脊柱融合。结论椎弓根螺钉固定能提供强大的三维矫正力,效果可靠、并发症少,应用椎弓根螺钉固定治疗特发性脊柱侧凸具有较好的临床效果。     

Surgical treatment and intraoperative spinal cord monitoring in scoliosis associated with chronic inflammatory demyelinating polyneuropathy: A case report

Abstract

There has been only one reported case of neuromuscular scoliosis following chronic inflammatory demyelinating polyneuropathy (CIDP). However, no cases of scoliosis that were treated with surgery secondary to CIDP have been previously described. A 16-year-old boy with CIDP was consultant due to the progression of scoliosis with the coronal curve of 86° from T8 to T12. Posterior correction and fusion with segmental pedicle screws were performed under intraoperative spinal cord monitoring with transcranial electric motor-evoked potentials. Although the latency period was prolonged and amplitude was low, the potential remained stable. Coronal curve was corrected from 86° to 34° without neurological complications. We here describe scoliosis associated with CIDP, which was successfully treated with surgery under intraoperative spinal cord monitoring.     

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     

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。     

Lenke 2型特发性脊柱侧凸三维矫形手术的有限元模拟

目的 利用建立的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,分别仿真模拟前路、后路手术矫形操作,探讨其最佳手术方案。方法 建立Lenke 2型AIS的有限元模型,分别模拟前路和后路共5种不同的矫形方案,比较不同手术方案的矫形效果和双肩平衡参数的变化。结果 5种不同矫形方案有限元模拟术后的上胸弯冠状面Cobb角和矫形率分别为:21.5(44.8%)、26.5(32.1%)、28.1(27.9%)、34.1(12.5%)、32(17.9%),各矫形方案的主胸弯矫正率无明显差别。胸椎矢状面生理后凸得以维持。5种矫形方案术后各双肩平衡影像学参数较术前有所升高,除方案A(上端固定椎为T2)外,其余各方案的喙突高度差均＞9 mm,锁骨角均＞2.5°,锁骨倾斜角差均＞4.5°。结论 对于左肩高的含结构性上胸弯Lenke 2型AIS,上端固定椎选择T2且完全融合上胸弯,可取得上胸弯、主胸弯良好的三维矫形和双肩平衡。部分融合上胸弯(上端固定椎为T3、T4),上胸弯的矫正率稍差,术后容易出现轻度到中度双肩失平衡。前路或后路选择性胸主弯融合,难以恢复上胸弯的正常脊柱序列,术后会导致轻度到中度双肩失平衡。     

前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效观察

目的：探讨前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效。方法2010~2012年103例脊柱结核患者经前路(第12胸椎以上经胸,第1腰椎以下经腹膜后)结核病灶清除和椎管减压术,椎间结构植骨,残余患椎短节段内固定。结果结核患者接受手术后,神经功能得到有效改善,影像学结果显示病灶平均后凸角明显下降(P <0.05)。术后随访发现,半年后植骨已融合,局部的后凸平均角度为13°,与术后相比无明显改变。此外,1年后患者内固定位置并无松动断裂,植骨无位移脱落,四肢活动正常,局部无叩、压痛。结论前路经病椎短节段有限固定融合治疗胸腰椎结核的近期临床疗效满意。     

后路同种异体骨治疗胸腰椎爆裂性骨折的前瞻性研究

目的:探讨同种异体骨移植在胸腰椎爆裂性骨折后路融合术中的使用效果?方法:对33例胸腰椎爆裂性骨折患者行同种异体骨或自体骨移植后路融合术,男21例,女12例,随机分为单纯使用同种异体骨移植组(16例)和采用自体髂骨移植(17例)?术后对两组患者的平均手术时间?出血量和并发症进行对比分析,术后24周时比较两组患者的融合率,采用Oswestry评分对两组患者进行功能评价?结果:与自体骨移植组相比,同种异体骨移植组手术时间明显缩短,失血量也明显减少?术后24周两组融合率均达到100%,Oswestry评分均无显著性差异?结论:在胸腰椎爆裂性骨折后路融合术中,同种异体骨移植可以取得满意的临床效果?