选择性前路手术治疗胸腰段或腰段青少年特发性脊柱侧凸的参数分析

目的 探讨Lenke5、6型青少年特发性脊柱侧凸(AIS)患者选择性前路手术的筛选指标.方法 回顾性分析我院1999年3月至2004年5月期间收治的52例Lenke5、6型AIS患者,随访2～4年(平均34个月),评估术前各相关参数.按术后结果 分成两组:满意组(胸弯减小)A组,不满意组(胸弯加重)B组.结果 A组(n=46)术前胸弯平均33°,术后平均18°,腰弯术前平均49°,术后平均21°.B组(n=6)术前胸弯平均38°,术后平均45°.腰弯术前平均46°,术后平均25°.B组患者中2例由于术后脊柱失平衡,进行了后路翻修术.结论 胸椎柔韧性和患者的成熟度决定了该方案外科手术的效果.在各种结构参数中,(TL/L:T)Cobb比率和胸椎柔韧性,是筛选患者的较好指标.

Analysis of the parameters about selective anterior fusion of thoracolumbar/lumbar curves in adolescent idiopathic scoliosis

OBJECTIVE: To establish criteria for AIS of Lenke5 and Lenke6 by an anterior only procedure of the lower curve fusion. METHODS: A retrospective study was conducted between March 1999 and May 2004 to investigate 52 AIS patients of Lenke5 and Lenke6. All the patients were observed 24 years (34 months on average). Many parameters were evaluated. At final assessment, two groups emerged: Group A had satisfactory results (the thoracic curve was reduced) and Group B had just the opposite. RESULTS: Preoperative thoracic curve in group A averaged 33 degrees and 18 degrees after surgery. The lumbar curve averaged 49 degrees before surgery and 21 degrees after surgery. In group B (n = 6), the average thoracic curve was 38 degrees before surgery and 45 degrees after surgery, whereas the lumbar curve averaged 46 degrees before surgery and 25 degrees after surgery. Two of these patients underwent posterior thoracic instrumentation and fusion because of the unreasonable balance. CONCLUSIONS: A successful surgical outcome was dependent on both the flexibility of the thoracic curve and the patients' maturity. The thoracolumbar/lumbar-thoracic (TL/L:T) Cobb ratio in combination with the flexibility of the thoracic curve were the best predictors among the structural indexes.