先天性脊柱侧凸合并冠状面骶骨倾斜的手术治疗

目的探讨先天性脊柱侧凸合并冠状面骶骨倾斜的临床特征及手术疗效。方法回顾性分析2007年1月—2013年12月山西医科大学第二医院骨科365例先天性脊柱侧凸患者中存在冠状面骶骨倾斜的11例患者的临床资料，其中男6例，女5例；年龄4—34岁，平均13．5岁；均为腰椎畸形病例。分析比较其手术前后冠状面骶骨倾斜角（CSS）、Cobb角、锁骨角（CA）、顶椎至骶中线（CSVL）的垂直距离（Apex—CSVL）、腰椎前凸角（LL）、骶骨倾斜角（SS）、骨盆投射角（PI）、骨盆倾角（PT）等参数的改变，并采用Wilcoxon符号秩和检验进行统计学分析。结果CSS、CA、LL、PI及PT等参数手术前后比较差异均无统计学意义（丁值分别为12．5、16．0、18．5、18．0、19．5，P值均〉0．05）；而手术后平均Cobb角由术前的48．5°改善为17．4°，平均Apex—CSVL由术前的3．2cm改善为1．8cm，平均SS由28．1°改善为33．8°，差异均有统计学意义（r值分别为0．0、0．0、5．0，P值均〈0．05）。结论先天性脊柱侧凸合并冠状面骶骨倾斜多发生于腰椎畸形的病例中，LL和SS较正常减小，手术治疗能够改善其冠状面和矢状面平衡。

Treatment for the congenital scoliosis with the coronal sacral tilt

Objective To analyze clinical characteristics of the congenital scoliosis with coronal sacral tilt and discuss the outcome for posterior correction. Methods A retrospective study was made in 365 cases with congenital scoliosis to pick out 11 cases whose sacrum tilted in coronal plane from January 2007 to December 2013. All the cases were lumber deformity and there were 6 males and 5 females aged from 4 to 34 years with the mean age of 13.5 years. We measured pre-operative and postoperative parameters such as coronal sacral slope （CSS） , Cobb angle, clavical angle （CA） , Apex-CSVL, lumber lordosis （LL） , sacral slope（ SS）, pelvic index（PI） and pelvic tilt（ PT）, to smake the comparative analysis. Results There were no differences between pre-operative and postoperative parameters such as CSS, CA, LL, PI and PT （ T = 12.5, 15.0, 18.5,18.0, 19.5, respectively, all P values 〉 0.05）, and the differences between pre- operative and past-operative parameters such as Cobb angle, Apex-CSVL and SS were statistically significant （ T = 0.0, 0.0, 5.0, respectively, all P values 〈 0.05）, the mean of the Cobb angle, Apex-CSVL and SS had been separately improved from 48.5° to 17.4°, 3.2 cm to 1.8 cm, 28.1° to 33.8°. Conclusions Coronal sacral tilt is usually companied with the lumber deformity, LL and SS decrease than normal. Correction can improve the balance in corona plane as well as saggital plane.