C-D Horizon、TSRH内固定对成人脊柱侧弯的疗效分析

目的 回顾分析C-D Horizon、TSRH系统在成人脊柱侧凸矫治中的应用并评价其疗效.方法 2003年8月～2006年1月间运用C-D Horizon、TSRH脊柱内固定系统治疗28例成人脊柱侧凸患者.包括成人特发性脊柱侧凸及退变性脊柱侧凸.采用前后路联合矫形或单纯后路矫形手术方法.术后随访1～2年(平均16个月).通过影像学资料对术前术后冠状面和矢状面的矫形效果对比分析并通过C7椎体中点距骶骨中心垂线的距离来分析躯干平衡的重建.并随访术后疼痛是否缓解及功能恢复.结果 所有患者术后外观矫形效果明显.侧凸术后主弯矫正率平均61.2%.末次随访主弯冠状面Cobb角平均丢失5.2°.C7中点距骶骨中心垂线由术前平均2.3 cm矫正为术后0.19cm.18例腰背疼痛的患者中16例术后得以缓解,24例患者术后参加正常的生活工作.结论 C-D Horizon、TSRH内固定系统治疗成人脊柱侧弯可得到冠状面上较高的矫正率、重建躯干平衡,有效矫正脊柱侧弯,术后功能恢复满意.     

应用钉-棒系统治疗退行性脊柱侧弯的疗效分析

目的回顾分析钉-棒系统内固定＋植骨融合治疗退行性脊柱侧凸矫治中的疗效。方法2004-01～2007-12间运用TSRH、CD脊柱内固定系统＋植骨融合治疗的42例退行性脊柱侧凸患者。采用后路矫形手术方法。术后随访6～25个月（平均15个月）。通过对术前术后影像学资料进行分析,比较冠状面和矢状面的矫形效果并通过c7椎体中点距骶骨中心垂线（CVSL）的距离来分析躯干平衡的重建,并随访术后疼痛是否缓解以及功能的恢复。结果所有患者术后外观矫形效果明显。侧凸术后主弯矫正率平均68．7％。末次随访主弯冠状面Cobb角平均丢失4．6°。C7中点距CVSL由术前平均2．7cm矫正为术后0．26cm。23例腰背疼痛的患者中17例术后得以缓解,31例患者术后参加正常的生活工作。结论钉棒系统＋植骨融合治疗退行性脊柱侧弯可得到冠状面上较高的矫正率、重建躯干平衡,有效矫正脊柱侧弯,术后功能恢复满意。     

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.     

后路TSRH治疗King Ⅳ型青少年特发性脊柱侧凸的术中配合

目的 :探讨后路TSRH治疗KingⅣ型青少年特发性脊柱侧凸术中配合的相关问题。方法 :采用后路TSRH治疗 6例KingⅣ型特发性脊柱侧凸 ,冠状面Cobb氏角平均 6 7.6°(5 2°～ 80°) ,所有病例均采用后路TSRH钩、钉、棒进行矫形、内固定、融合。结果 :手术时间平均 15 0min ,术中出血平均 30 0ml,Cobb氏角平均矫正 5 5 .5° ,矫正率为 82 .1% ,矫形丢失率为 1.7%。结论 :采用TSRH治疗KingⅣ型侧凸效果良好 ,术中配合好能缩短手术时间、减少术中出血及脊髓损伤的可能性     

后路半椎体切除椎弓根螺钉内固定治疗儿童先天性脊柱侧凸

目的:探讨后路半椎体切除加椎弓根螺钉内固定治疗儿童先天性脊柱侧凸的临床疗效。方法:以后路半椎体切除加椎弓根螺钉内固定治疗半椎体畸形所致先天性脊柱侧凸儿童15例,均为完全分节性半椎体畸形。其中2例行凸侧椎弓根螺钉固定,其余均行双侧椎弓根螺钉固定。术后随访,摄脊柱正侧位X线片,比较手术前后冠状面Cobb角及后凸角度矫正情况。结果:所有患者均得到随访,随访时间12～25个月,平均17个月。脊柱冠状面平均Cobb角由术前47.5°矫正至16.1°,矢状面平均后凸角由术前31°矫正至12.7°。末次随访矫正效果无丢失。所有患者均未出现神经损伤、感染等并发症,内固定无松动。结论:后路半椎体切除加椎弓根螺钉内固定治疗半椎体畸形所致先天性脊柱侧凸安全、有效,矫正效果满意。     

先天性脊柱畸形患者后路半椎体切除结合内固定系统疗效分析

目的 观察后路半椎体切除结合内固定系统对先天性脊柱畸形患者的治疗效果.方法 选择我院2007年8月～2010年3月收治的先天性脊柱畸形患者42例作为本次研究对象,采取后路半椎体切除结合内固定系统进行治疗.手术后定期采用X线片对全长脊柱正侧位进行观察以观察脊柱融合、内固定稳定情况和畸形矫正率等情况.结果 所有患者均被随访,时间为24～48个月,平均为34个月.两组患者平均手术时间与出血量、术前与术后冠状面Cobb角的矫形角与后凸Cobb角和末次随访时的数值如表1所示.术后两角度与末次随访时角度与手术前的角度相比,差异均有统计学意义(P＜0.05).结论 后路半椎体切除结合内固定系统对先天性脊柱畸形患者的疗效显著,能显著减少主弯冠状面与主弯后凸的Cobb角,适合在今后临床治疗中推广使用.     

三维节段脊柱内固定系统在脊柱矫形术中的应用

目的评价三维节段脊柱内固定系统在不同脊柱畸形中的应用效果.方法应用三维节段脊柱内固定系统CD、TSRH等治疗脊柱畸形26例,其中特发性侧凸19例,先天性侧凸2例,后凸畸形5例,均以后路矫形自体骨植骨融合.结果所有病例经6～27个月随访,平均10.4个月.侧凸冠状面畸形平均矫正率为61.4%;矢状面后凸术后平均32.5°;旋转畸形平均矫正Ⅰ度,顶椎最大偏距平均矫正率为65.1%;后凸畸形平均矫正率为59.2%.所有病例无脱钩、断棍、感染、骨折以及脊髓神经损伤.结论三维节段脊柱内固定系统不仅可以完成畸形的三维矫正,而且矫正可靠,稳定性高,术后可不用石膏固定.     

后路选择性椎弓根螺钉内固定矫正青少年特发性脊柱侧凸

目的探讨后路选择性节段椎弓根螺钉内固定治疗青少年特发性脊柱侧凸（AIS）的效果。方法47例AIS患者均行后路矫形,术前均行详细的临床和影像学检查评估,术后及随访时拍X线片,对侧凸Cobb角、顶椎旋转度、躯干偏移进行测量和分析。结果术后全部患者获11—48个月随访,平均16．6个月。手术前主侧凸Cobb角平均为53．4°±10．7°,术后平均为12．5°±5．3°,平均矫正率为68．0％,终末随访矫正丢失率平均2．1％。本组患者均无躯干失平衡及断钉、断棒。结论后路选择性节段椎弓根螺钉系统治疗青少年特发性脊柱侧凸可获得良好的临床效果。     

35例后路脊椎切除术治疗严重脊柱侧后凸畸形

目的 探讨严重脊柱侧后凸畸形行后路脊椎全切除术(vertebral column resection,VCR)的可行性和临床意义.方法 回顾性分析35例严重脊柱侧凸或后凸Cobb角大于100°的重度脊柱侧后畸形的患者资料;术前患者侧凸主弯冠状面Cobb角平均为(124.8±27.4)°,胸腰段矢状位后凸角平均为(95.8±30.2)°.结果 平均手术用时为(5.9 ±1.2)h,术中平均出血量为(1855±1200)ml,术后未出现神经系统症状加重的患者,且无伤口感染等并发症.术后平均下床时间为(11±5)d;术后侧凸主弯冠状面Cobb角平均为(45.7±6.2)°,胸腰段后凸为(38.6±10.1)°,矫正率达到79%,患者的躯干和双肩失平衡均得到了显著的改善.结论 后路全脊椎切除术可使神经充分的减压,矫正侧后凸畸形效果满意,是治疗严重脊柱侧后凸畸形安全有效的方法.     

后路半椎体切除治疗先天性脊柱侧凸

目的探讨后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸的临床效果。方法采用一期后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸畸形15例。术中咬除半椎体的后部附属结构,沿椎弓根外侧壁剥离至椎体前缘,切除半椎体、上下椎间盘及邻近椎体的软骨面,通过内固定器械凸侧加压闭合畸形椎切除后所致的间隙,矫正脊柱畸形。术后定期门诊复诊,观察脊柱融合、畸形矫正率和内固定稳定情况。结果本组15例均获得随访,随访时间12~36个月,平均24个月。术前侧凸Cobb角35°~78°,平均57°,术后Cobb角15°~36°,平均25°,矫正率54%;术前后凸Cobb角22°~65°,平均45°,术后后凸Cobb角8°~36°,平均18°,矫正率60%。术后未发现脊髓、神经损伤,无内固定松动,无切口感染。结论后路半椎体切除、器械矫正内固定治疗先天性脊柱侧凸是一种安全、有效的矫正方法。     

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…     

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.     

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     

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.     

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。     

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.     

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

CONGENITALspinaldeformitiesareusuallyduetovertebraldevelopmentaldisordersduringthefirst8weeksofgestation,1thisperiodalsoin volvesclosureoftheneuraltube,thuspatientswithcon genitalspinaldeformitiesmayalsohaveneuraltubedeform itiesamongstwhichsplitspinalcor…     

支点弯曲柔韧性对成人特发性脊柱侧凸矫形效果的评估意义

目的 了解支点弯曲像柔韧性(FBF)与手术治疗成人特发性脊柱侧凸矫形率(CR)的关系,探讨支点弯曲柔韧性对成人脊柱侧凸矫形手术效果的评估能力.方法 对69例进行手术治疗的特发性成人脊柱侧凸患者拍摄术前站立位、支点弯曲位和术后站立位X线片,测量其胸段/胸腰段脊柱侧凸的Cobb角,计算支点弯曲柔韧性和矫形率,对二者进行统计学分析.结果 使用数据分析软件SPSS 10.0对FBF和CR率进行回归分析,得出:CR=0.213+0.768×FBF,即支点弯曲柔韧性每提高1个单位,矫形率提高0.768个单位(P<0.01).结论 支点弯曲矫形率和手术矫形率存在明显的线性关系,使用此方程,可对符合条件的多病例样本进行矫形率预测,能够客观评估新的矫形器械或矫形方法的矫形效果.