前路与后路矫形融合术治疗腰段和胸腰段青少年特发性脊柱侧凸的疗效比较

目的 分析前路和后路矫形融合术治疗胸腰段和腰段青少年特发性脊柱侧凸(AIS)的临床疗效.方法 2004年1月至2008年8月手术治疗胸腰段和腰段AIS患者42例,均为女性.前路组22例,年龄12～18岁,平均14.5岁;采用侧前方入路,单棒或双棒系统矫正固定融合.后路组20例,年龄11～19岁,平均14.8岁;采用节段椎弓根螺钉内固定融合技术.对两组手术时间、出血量、冠状面和矢状面校正率、融合节段以及SRS-24评分进行比较,并进行统计学分析.结果 术后随访12～63个月,平均28.3个月.前路组与后路组平均手术时间分别为(334±36)和(292±17)min,术中平均出血量分别为(940±207)和(596±227)ml,平均融合椎体数分别为(5.2±0.8)和(6.7±1.2)个;两组差异均有统计学意义(P<0.05).前路组与后路组冠状面腰弯.胸腰弯矫正率分别为(93±5)%和(88±5)%,平均SRS-24评分分别为98和94;两组差异均无统计学意义(P>0.05).结论 后路矫形融合术手术时间较短、出血量较少,能够达到与前路手术相同的矫正率,但融合节段较长.

Comparison of surgical treatment in single thoracolumbar-lumbar adolescent idiopathic scoliosis:anterior versus posterior surgery

Objective To retrospectively compare the clinical outcomes of anterior and posterior surgical treatment in single thoracolumbar-Iumbar adolescent idiopathic scoliosis. Methods Between January 2004 and August 2008, 22 female patients, averaged 14. 5 years old (12 to 18 years), of thoracolumbar-Iumbar adolescent idiopathic scoliosis were corrected by anterior correction and fusion. At the same time, 20 female patients, average 14.8 years old (11 to 19 years), were corrected by posterior segmental pedicle screw correction and fusion. Operation time, SRS-24 score, intraoperative blood loss, and coronal and sagittal plane correction were compared between the two groups. Results All patients were followed up for 12 to 63 months, the mean follow-up time was 28. 3 months. Operation time was (334 ± 36 ) min in anterior group and (292 ± 17) min in posterior group; intraoperative blood loose was ( 940 ± 207 ) ml in anterior group and (596 ±227) ml in posterior group; fusion levels were (5. 2 ±0. 8) in anterior group and (6. 7 ± 1. 2) in posterior group. There were statistically significant difference in operation time, intraoperative blood loss and fusion levels (P<0. 05). Coronal correction was(93 ±5)% in anterior group and(88 ±5)% in posterior group. SRS-24 scores averaged 98 in anterior group and averaged 94 in posterior group. There was no statistical difference in coronal correction or SRS-24 scores (P > 0.05). Conclusions Posterior surgery has the same correction results compared with anterior surgery in treating thoracolumbar-lumbar adolescent idiopathic scoliosis. Posterior surgery takes less operation time, brings less trauma but has longer fusion levels.