选择性前路胸腰段或腰段融合治疗青少年特发性脊柱侧凸

目的 评价选择性前路胸腰段或腰段融合治疗PUMCⅡd1型(Lenke5型)青少年特发性脊柱侧凸(AIS)的临床效果. 方法回顾性分析35例行选择性前路胸腰段或腰段融合的PUMCⅡd1型(Lenke5型)AIS病例.所有病例均行前路单棒节段性固定融合,随访18～42个月,平均36个月.术前、术后及随访时均摄站立位全脊柱正侧位X线片,对躯干偏移、上下融合椎邻近椎间盘开角、下固定椎的倾斜、冠状面和矢状面Cobb角进行测量分析.测量数据使用SPSS 11.0统计学软件进行分析.结果 胸腰弯或腰弯冠状面Cobb角术前平均45.6°,术后9.7°,末次随访14.4°.胸弯冠状面Cobb角术前平均29.7°,术后17.6°,末次随访20.1°.躯干偏移术前平均14.0 mm,术后14.8 mm,末次随访5.1 mm.下端固定椎(LIV)倾斜术前平均-21.8°,术后-1.5°,末次随访-2.1°.冠状面上端固定椎(UIV)上位椎间盘开角(UIVDA)及LIV下位椎间盘开角(LIVDA)术前分别为0.5°和0.6°,术后为0.9°和4.9°,末次随访时均显著加重,为3.0°和7.8°.矢状面胸段(T5～12)及胸腰段(T10～L2)曲度术后及末次随访时均保持良好.矢状面腰前凸(L1～S1)及固定融合节段Cobb角在术后有所减小,末次随访时均保持良好.所有病例末次随访时均未见假关节形成及其他并发症. 结论 选择性前路胸腰段或腰段融合是治疗PUMCⅡd1型(Lenke 5型)AIS的安全、有效的方法,融合节段上、下椎间盘开角增加及部分病例残余胸弯过大现象需进一步随访评估.

Selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis

Objective To evaluate the outcomes of selective anterior thoracolumbar or lumbar (TL/L) fusion for adolescent idiopathic scoliosis (AIS) with PUMCⅡd1 curves (Lenke type 5). MethodsThirty-five consecutive AIS patients (PUMC type Ⅱd1, Lenke type 5) with selective anterior TL/L fusion with single solid rod instrumentation were reviewed. The average follow-up was 36 months (range, 18-42 months). Standing anterioposterior and lateral radiographs were measured and analyzed. Results The average preoperative Cobb angle of the TL/L curves was 45.6° and corrected to 9.7° postoperatively, with 79.7% curve correction. The thoracic curves decreased from 29.7° preoperatively to 17.6° postoperatively, with a spontaneous correction of 41.5%. There was an average 4.7°and 2.5° correction loss of the TL/L and the thoracic curves at the final follow-up respectively. Trunk shift deteriorated slightly from 14.0 mm preoperatively to 14.8 mm postoperatively, and improved significantly to 5.1 mm at the final follow-up. The lowest instrumented vertebra (LIV) tilt was significantly improved after surgery (from -21.8° preoperatively to -1.5° postoperatively) and well maintained at the final follow-up (-2.1°). The coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) averaged 0.5° and 0.6° respectively, and aggravated after surgery (0.9° and 4.9°, respectively). Both the UIVDA and LIVDA were significantly aggravated at the final follow-up (3.0° and 7.8°, respectively). The sagittal contours of T5-12 and T10-L2 were well maintained after surgery and at the final follow-up. The lumbar lordosis of L1-S1 and the sagittal Cobb angle of the instrumented segments were reduced postoperatively and at the final follow-up. No pseudarthrosis or other complications were observed. Conclusion Selective anterior TL/L fusion with single solid rod instrumentation is effective and safe for AIS with PUMCⅡd1 (Lenke type 5) curves, above and below the fusion and larger residual thoracic curve in some cases need further evaluated.