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。

Clinical Research on Thoracolumbar Idiopathic Scoliosis by Anterior and Posterior Approach

Objective： To compare the therapeutic effect of posterior and anterior approach for correcting thoracolumbar idiopathic seoliosis. Methods： According to the same standard, we picked out 61 cases from 231 adolescent idiopathic scoliosis patients who were operated from January 1998 to January 2006. 28 patients （group A） were operated by anterior approach and 33 patients （group B） by posterior approach. Results： The follow-up duration was 2-6 years （average 3.5 years）. Operation time in group A was 4.5±0.8 hours and 3.1±1.0 hours in group B （P〈0.01）. Volume of blood lost was 1400±350ml in group A and 1200 ±230ml in group B （P〈0.05）. Draining volume was 380±190ml in group A and 250±150ml in group B （P〈0.05）. Fixed segments were 4.5±0.6 centrums in group A and 7.1±1.2 centrums in group B （P〈0.01）. Average rate of correction was 75% in group A and 74% in group B （P〉0.05）. Degree of eon＇ection lost in 2 years was 4.3°±1.4° in group A and 5.4°±2.1° in group B （P〉0.05）. Correction degree of razorback was 3.8°±2.4° in group A and 4.1°±2.6° in group B （P〉0.05）. There was no pseudoarthrosis and internal fixation failure noted. The incidence of proximal junction kyphosis was higher in group B （P〈0.01）. Conclusion： Therapeutic effect is similar in deformity correction degree and eorrection lost between two groups. Posterior approach has an advantages of minor trauma, small amount of bleeding and drainage, but easy to lead to PJK.