Lenke 5型脊柱侧凸前路单棒矫形术中放置钛网对术后矢状面重建的影响

目的 探讨放置钛网对Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)行选择性前路单棒矫形加植骨融合术后矢状面重建的影响.方法 40例Lenke 5型AIS患者,根据术中植骨方式分为两组,均接受选择性前路单棒矫形术.术中椎间融合植骨时,A组患者放置钛网,B组则单纯以剪碎的自体肋骨和髂骨骨粒植骨.A组女19例,男1例;年龄12～18岁.B组女17例,男3例;年龄13～20岁.两组患者获得1.5年以上的随访.对术前、术后和末次随访时的冠状面矫形与矢状面重建指标进行分析.结果 在术后和随访中,两组患者主弯的矫正率大于70%,继发弯也获得较满意的自发性纠正.无内固定相关和假关节形成等并发症发生.两组患者术后和随访中也获得较满意的矢状面重建.其中,术后和随访中胸椎后凸增加,胸腰交界性后凸轻微变化,腰椎前凸无明显丢失,内固定近端后凸成角轻度增大,内固定区成角前凸轻度减小,这些指标在两组间差别无统计学意义.末次随访时,A组患者SVA和L1到C7PL线的距离平明显小于其术前和术后的测量值,而这些指标在B组均无显著变化.结论 选择性前路单棒矫形加椎间植骨融合术是治疗Lenke 5型脊柱侧凸的有效方法.与自体植骨相比,钛网植骨可较好地改善矢状面的整体平衡.

The effect of interbody cage support on the sagittal profile reconstruction after anterior selective correction in idiopathic scoliosis patients with a Lenke type 5 curve

Objective To investigate the long-term effect of interbody cage support on the sagittal profile reconstruction after anterior selective correction in adolescent idiopathic scoliosis (AIS) patients with a Lenke type 5 curve. Methods Totally 40 AIS patients with a Lenke type 5 curve who received anterior selective single rod instrumentation and fusion were divided into two groups. During grafting in the surgery, a structural interbody cage was placed in group A, including 19 girls and 1 boy, aging 12-18 yrs; while morsellized autogenous rib or iliac bone in group B, including 17 girls and 3 boys aging 13-20 yrs. All pa- tients were followed up for more than one year and a half. The coronal correction of the scoliosis and the sagittal profile reconstruction were evaluated retrospectively. Results At final follow-up, more than 70% correction was achieved for the primary curve and a spontaneous correction for the secondary curve in both groups. No instrumentation-related complications or pseudarthrosis occurred. And similar postoperative changes were found between group A and group B, such as the increase in thoracic kyphosis, slight change in thoracohmbar junctional kyphosis, no significant loss of lumbar lordosis, and mild increase in proximal junctional measurement, as well as mild lordosis loss of the instrumented segments. In group A, the sagittal vertical axis improved from -24 mm postoperatively to -15 mm, and the distance between L1 and C7 plumb line decreased from -24 mm postoperatively to -12 mm, while there were no obvious changes in group B. Conclusion Anterior selective single rod instrumentation and fusion is a recommended method for treating AIS of Lenke type 5. Regarding the sagittal reconstruction, a structural interbody cage can bring a better to- tal balance during the long-term follow-up.