双侧肋骨截骨结合后路矫形固定治疗重度僵硬性脊柱侧凸

目的探讨双侧肋骨截骨结合后路广泛松解椎弓根钉矫形治疗重度僵硬性脊柱侧凸的临床疗效。方法自2005年6月~2010年3月采用后路广泛松解结合双侧肋骨截骨(凹侧肋骨截骨抬高,凸侧肋骨切除胸廓成型术)矫治重度僵硬性脊柱侧凸18例。结果每例凹侧肋骨抬高数为3～6根,平均4.5根,凸侧肋骨切除数为3～5根,平均3.5根,肋骨切除长度为5～6 cm。术后主弯Cobb角冠状面为45.3°(38～87°),矫正率平均为54.1%;"剃刀背"畸形7～16°,平均11.2°,双侧背部高度差3.3 cm(1.8～4.3 cm),术后1年肺活量1.3～4.5 L,平均2.5 L,第1秒用力呼气容积FEV1.0 0.8～3.8 L,平均2.0 L。2例出现胸腔积液,2枚胸椎弓根钉误入椎管,未累及硬脊膜。结论后路广泛松解和一期双侧肋骨截骨术可显著改善侧凸的柔韧性,提高矫形效果,对肺功能无不良影响。

Concave-convex ribs osteotomy combined with posterior instrumentation for correction of severe and rigid idiopathic scoliosis

Objective To explore the feasibility and clinical efficacy of the concave-convex ribs osteotomy combined with posterior instrumentation for the treatment of severe and rigid idiopathic scoliosis.Methods From June 2005 to March 2010,18 patients with severe and rigid idiopathic scoliosis were treated by posterior surgery with concave-convex ribs osteotomy.Results All patients had a mean of 25 months follow up(12～48 months).The mean number of ribs resected was 4.5(3~6) on concave side and 3.5(3～5) on convex side.The average length removed was 5~6 cm.The postoperative Cobb angle was 45.3°(38~87°) and the average correction rate was 54.1%.The average postoperative difference in back-height was 3.3 cm and the rib prominence was 11.2°(7~16°).The average postoperative vital capacity was 2.5 L(1.3~4.5 L) and FEV1.0 was 2.0 L(0.8~3.8 L).Two cases had pleural effusion,2 thoracic pedicle screws inserted into spinal canal which did not involve dura.Conclusion The posterior spinal fusion and concave-convex ribs osteotomy are effective for correction of SRIS improving flexibility and appearance,without adversely affecting pulmonary function in long-term follow-up.