前路松解术在重度青少年特发性脊柱侧凸治疗中的价值

目的探讨前路松解在重度青少年特发性脊柱侧凸治疗中的作用. 方法回顾性分析1998年1月至2001年12月间26例重度脊柱侧凸的手术治疗结果,其中男7例,女19例;年龄平均15岁(10～21岁).24例可根据King对特发性脊柱侧凸的分型,其中King Ⅰ 4例,King Ⅱ 9例,King Ⅲ 5例,King Ⅳ 4例,King Ⅴ 2例;另2例为胸腰段侧凸.术前站立位主侧凸平均89.8°,重力悬吊牵引位平均66.5°,反向弯曲位平均67.7°,支点反向弯曲平均为61.2°,胸椎后凸平均43.5°.术前顶椎偏离骶正中线的距离为39.7 mm.前路松解后一期行后路手术6例,2周后二期行后路手术治疗20例. 结果 20例二期后路手术者,前路松解术后脊柱活动度与术前悬吊位X线片比较,平均增加了17.8°.术后主侧凸冠状面Cobb角平均52.6°,胸椎后凸28.4°.冠状面平均矫正38.2°,矫正率平均43.1%,术后顶椎偏离骶正中线的距离为9.9 mm.随访时间平均2.3年(6个月～4年),随访时主侧凸平均Cobb角54.9°,矫正丢失6.4%,无断棍、植骨不融合及假关节的病例. 结论重度侧凸术前侧凸的柔韧性<20%的患者,单纯前路松解对增加脊柱的活动度意义不大,术后畸形的矫正效果不佳,应考虑前路的截骨来增加脊柱的柔韧性以使侧弯得到最大限度的矫正.

The effect of anterior spinal release on severe adolescent idiopathic scoliosis

OBJECTIVE: To explore the effect of anterior spinal release on severe scoliosis. METHODS: Twenty-six cases of severe scoliosis were retrospectively reviewed from January 1998 to December 2001. There were 7 males and 19 females with an average age of 15 years (ranging from 10 to 21 years). Twenty-four cases were classified according to King classification for adolescent idiopathic scoliosis, including King type I 4 cases, type II 9 cases, type III 5 cases, King IV 4 cases, King V 2 cases; another two cases were thoracolumbar curve. The major curves were averaged respectively 89.8 degrees, 66.5 degrees, 67.7 degrees, 61.2 degrees on standing, traction, bending and fulcrum film before operation. The distance of apex vertebrae deviated from sacral midline was 39.7 mm before operation. RESULTS: Six cases received anterior spinal release with posterior correction by one stage, 20 cases by two stages. The cases with two stage operation increased the spinal flexibility about 17.8 degrees after anterior release. The major curve was 52.6 degrees on average, and the distance of apex vertebrae deviated from sacral midline was 9.9 mm after operation. The major curve was 54.9 degrees on average, loss the correction 6.4% during follow-up. There was no complication related to the operation in this group. CONCLUSIONS: The anterior spinal release alone has little effect on severe scoliosis with flexibility less than 20% preoperation. The curve can be corrected to a great degree by anterior osteotomy for spine.