早发性脊柱侧凸的非手术治疗

<正>根据脊柱侧凸研究会(Scoliosis Research Scociety,SRS)制定的标准,在10岁(不包括10岁)之前发生的所有类型脊柱侧凸畸形定义为早发性脊柱侧凸(early onset scoliosis,EOS),包括特发性的(Idiopathic)和非特发性的(Non-idiopathic)脊柱侧凸。而早期文献[1]和著作[2]报道将早发性脊柱侧凸的年龄界限规定在5岁之前。正常情况下[3~6],0~5岁T1~S1高度平均增长10cm,T1~T12增长7cm;5~10岁T1~S1高度平均增     

PRSS治疗早发幼儿型进展性脊柱侧弯

[目的]评价PRSS治疗幼儿进展性脊柱侧弯的矫正效果和观察脊柱生长期维持矫正的情况.[方法]2000年6月以来,作者对23例幼儿进展性脊柱侧弯用PRSS进行一次性矫正,不植骨融合,随诊分析手术时年龄分布,手术前后脊柱侧弯角度变化,脊柱固定节段的生长情况和并发症.[结果]平均随访时间2.8年,5例在5年以上.术前平均侧弯角度为80.7°,术后矫正角度30.5°,平均矫正率62.2%.随访侧弯角度平均34.7°,与术后进行比较P＞0.05,表明侧弯矫正角度无明显丢失,无严重的并发症发生.脊柱固定节段平均生长13.3 mm.[结论]PRSS治疗进展性幼儿脊柱侧弯,不需植骨融合一次手术即可满意矫正侧弯和在脊柱生长期维持矫正且不影响固定节段的脊柱生长,是一种较理想的矫正生长期儿童脊柱侧弯的矫形装置.     

The operative treatment of congenital scoliosis. A report of 23 patients

Spinal fusion was performed in 23 patients with congenital scoliosis. Various procedures were used including posterior fusion and without instrumentation. No surgical procedure proved to be superior for obtaining correction regardless of the use of supplemental instrumentation. The use of Knodt or Harrington Instrumentation could not be correlated with a lower pseudoarthrosis rate, shorter postoperative immunobilization period, or a decrease in postoperative loss of correction. The morbidity associated with these surgical procedures was high (48%). Thoracic curves were more prone to lengthen or develop kyphoses postoperatively. A high incidence of varied congenital anomalies was found in association with congenital scoliosis. A through work-up including an intravenous pyelogram and myelogram is strongly recommended prior to the operative treatment of congenital scoliosis.     

早发性脊柱侧凸的手术治疗进展

<正>最初早发性脊柱侧凸(early onset scoliosis,EOS)是指5岁之前因各种病因导致的脊柱侧凸畸形[1]。根据脊柱侧凸研究协会(Scoliosis Research Society,SRS)的最新定义及文献报道[2、3],10岁之前因各种病因导致的脊柱侧凸畸形均可称为EOS畸形,如婴幼儿特发性脊柱侧凸、先天性脊柱侧凸、神经肌肉型脊柱侧凸等。EOS定义的根据是     

A physiological approach to surgical treatment of progressive early idiopathic scoliosis

The results of previous clinical and experimental studies have provided accumulated evidence for the role of rib asymmetry in the pathogenesis of idiopathic scoliosis (IS). Moreover, it has been shown that scoliosis induced in rabbits can be corrected by elongation or growth stimulation of ribs on the side of the convexity. Taking these observations into consideration, a 7-year-old girl with right convex thoracolumbar IS was operated upon by 2-cm shortening of three concave ribs. The preoperative coronal Cobb angle was 46° and the sagittal angle was 55°. Twenty-seven months after the operation the curves were reduced to 21° and 35°, or by 54 and 36%, respectively. It is concluded that new, easy to perform and harmless interventions on the ribs may have vast implications for the overall treatment of young patients with early progressive, thoracic, IS. Received: 31 May 1997 Revised: 20 March 1998 Accepted: 8 April 1998     

生长棒技术治疗早发性脊柱侧凸的新进展

早发性脊柱侧凸发病年龄早,畸形进展快。临床上治疗畸形严重、侧凸进展快的长节段早发性脊柱侧凸时支具及石膏固定等保守治疗效果差;传统的融合矫形手术会导致躯干短小、心肺功能不全;非融合生长棒技术是目前治疗EOS较理想的方法。获得较好的矫形效果、维持矫形效果、避免反复手术延长内置物而保留脊柱的生长及尽可能的降低手术并发症是生长棒治疗EOS的热点话题。近年来不断有新的生长棒技术应用到治疗EOS领域中。     

The operative treatment of congenital scoliosis

Summary The experiences with 26 personal cases of congenital scolioses operated on between 1970 and 1980 are presented. The average postoperative follow-up is 3/12 years. The natural complexity of spine malformations with predominant lateral deviation is discussed and demonstrated. Accordingly, a number of varying anterior and posterior operative methods were used in the individual case. The scope of operative methods used in this series is outlined. Characteristic patterns of spine malformations and the individual sequence of operative procedures applied are explained and documented by case demonstrations. The overall correction of all curves operated on was 38%. When cases chosen for combined staged anterior and posterio surgery were looked at separately the percentage of average correction rose to 51%.

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Zusammenfassung Es wird über 26 eigene Fälle von kongenitalen Skoliosen berichtet, die zwischen 1970 und 1980 operiert worden sind. Die mittlere postoperative Beobachtungszeit beträgt 3/12 Jahre. Die Komplexität operationsbedürftiger Wirbelsäulenmiß-bildungen wird aufgezeigt und unterteilt. Entsprechend wurden häufig verschiedene ventrale und dorsale Operationsmethoden im gleichen Fall zur Korrektur eingesetzt. Die gewählten Operationsmethoden werden im einzelnen kurz gestreift. Charakteristische Mißbildungsmuster mit ihrer individuell typischen Sequenz von operativen Eingriffen werden herausgearbeitet und durch je einen Fall belegt. Die Gesamtkorrektur der operierten Kurven betrug 38%, bei Kombination ventraler und dorsaler Operationsmethoden stieg das durchschnittliche Korrekturergebnis auf 51%.

     

滑动生长棒技术治疗儿童早发性脊柱侧凸的初步研究

[目的]探究滑动生长棒技术治疗早发性脊柱侧凸(early onset scoliosis, EOS)的临床疗效。[方法]对于2013年1月～2016年9月本科收治的9例EOS患者采用滑动生长棒技术手术治疗。以T_1～S_1、T_1～T_(12)和固定节段的高度作为脊柱生长的主要评价指标,同时测量患者术前、术后和末次随访时的冠状面和矢状面参数。记录随访期间再手术次数和各类并发症情况。[结果] 9例患儿随访24～49个月,平均(28.74±7.62)月。主弯Cobb角由术前的(70.33±10.47)°显著纠正至术后1周的(26.19±6.80)°(P0.05),末次随访时为(23.03±5.12)°。T_1～S_1高度由术前(23.74±2.27) cm,显著增至术后1周的(27.42±2.11) cm,末次随访时为(30.42±2.37) cm,不同时间点间的差异有统计学意义(P0.05);T_1～T_(12)高度由术前(14.53±1.82) cm,显著增至术后1周(16.65±1.93) cm,末次随访时(18.92±2.11) cm,不同时间点间的差异有统计学意义(P0.05);固定节段高度由术后1周的(19.26±2.17) cm显著增加至末次随访的(21.54±2.25) cm(P0.05)。术后2年时,固定节段高度增加了1.32 cm,固定节段生长速度为0.66 cm/年。术后仅1例出现Adding-on现象,1例于术后2年6个月更换更长的金属棒。无手术切口感染、断钉、断棒等并发症。[结论]滑动生长棒技术在纠正EOS侧弯的同时有效保留了脊柱生长潜能,有效减少了撑开手术次数,降低了手术并发症。     

Porcine model of early onset scoliosis based on animal growth created with posterior mini-invasive spinal offset tethering A preliminary report

Several models of scoliosis were developed in the past 10 years. In most of them, deformations are induced in old animals and required long time observation period and a chest wall ligation ± resection. The purpose of the study was to create a scoliosis model with a size similar to an early onset scoliosis and an important growth potential without chest wall injuring. An original offset implant was fixed posteriorly and connected with a cable in seven (6 + 1 control) one-month-old Landrace pigs. The mean initial spinal length (T1-S1) was 25 cm and the mean weight was 9 kg. After 2 months observation, spinal deformities were assessed with a three dimension stereographic analysis. In four animals, the cable was sectioned and the deformities followed-up for next 2 months. No post-operative complication was observed. Mean weight growth was 10 kg/month and mean spine lengthening (T1-S1) was 7 cm/month. In 2 months, we obtained structural scoliotic curves with vertebral and disk wedging which were maximal at the apex of the curve. Mean frontal and sagittal Cobb angles was 45°. Chest wall associated deformities were similar to those observed in scoliotic deformities and were correlated to spinal deformities (p = 0.03). The cable section resulted in a partial curve regression influenced by disk elasticity and could probably be influenced by gravity loads (Decrease of the Cobb angle of 30% in the sagittal plane and 45% in the frontal plane). According to the results, the model creates a structural scoliosis and chest wall deformity that is similar to an early onset scoliosis. The spinal deformities were obtained quickly, and were consistent between animals in term of amount and characteristic.     

Segmental spinal instrumentation in idiopathic scoliosis. A preliminary report

Eighty-six patients with idiopathic scoliosis who underwent a posterior spinal fusion using sublaminar segmental spinal instrumentation were analyzed retrospectively. There were two operative groups: group 1, 66 patients who had Harrington rod instrumentation and segmental wiring, and group 2, 20 patients who had Luque rod instrumentation. The clinical and radiographic data of the two groups were similar except for the passage of more sublaminar wires and increased intraoperative blood loss in group 2. Twenty intraoperative or postoperative complications occurred in 19 patients (22%) including 14 neurologic complications. Three patients (3%) had major spinal cord injuries, while 11 patients (13%) had transient sensory changes. There was no significant difference in the incidence of neurologic complications between group 1 or group 2. The remaining intraoperative complications were due either to anesthesia, positioning during surgery, or technique (dural tear). Late complications occurred in two patients in group 1 only: one each with rod breakage and hook displacement. Only one patient (1%) has required additional surgery. Our results indicate that although segmental instrumentation can be beneficial in idiopathic scoliosis, the incidence of complications, primarily neurologic, will be higher than expected. The major reason appears to be surgeon inexperience with passage of sublaminar wires. As experience increases, the incidence of complications declines and becomes comparable with conventional Harrington rod instrumentation alone.     

Correction of degenerative scoliosis of the lumbar spine. A preliminary report

The use of the spinal internal skeletal fixation system (ISFS), originally developed for fracture treatment by Dick for the segmental correction of scoliosis, is demonstrated in eight adult degenerative lumbar spinal curves. The two main benefits of an intrapedicular screw fixation system, i.e., excellent skeletal stabilization and the ability to freely modify individual segmental vertebral position, are clearly demonstrated in this instrumentation, which is still at the prototype stage. The good preliminary results seen in this series encourages the further development of segmental intrapedicular spinal fixation systems for the treatment of scoliosis.