Cantilever bending technique for treatment of large and rigid scoliosis

Objective To assess the efficacy and clinical value of cantilever bending technique as a technique for correcting large （ ≥ 70°） and rigid （ flexibility ≤ 30 % ） scoliosis. Methods From 1998 to 2002,a total of 41 consecutive patients undergoing cantilever bending technique for the management of large and rigid scoliosis of any etiology （congenital, idiopathic, or neuromuscular） and followed up for at least 2 years were included. There were 12 males and 29 females with an average age of 31.1 years （ 11～61）.     

椎弓根螺钉技术治疗胸椎脊柱侧凸并发症分析

目的：探讨椎弓根螺钉技术治疗胸椎脊柱侧凸畸形并发症的发生及防治。 方法：自1994年3月到2005年3月应用徒手法螺钉植入技术进行后路椎弓根螺钉钉棒系统治疗脊柱侧凸畸形183例,其中青少年特发性脊柱侧凸110例,成人脊柱侧凸32例,先天性脊柱侧凸28例,马方综合征合并脊柱侧凸7例,其他原因引起的脊柱侧凸6例。所有患者均进行术前、术后及随访期脊柱侧凸Cobb角的测量,根据测量结果计算矫形率,并统计分析围手术期及随访期并发症的发生率。 结果：本组病例畸形矫正率为72%,矫形效果与文献报道的钩棒系统比较有一定的优势;本组病人围手术期并发症发生率为8.4%（术中椎弓根爆裂1.5%,术后感染3.8%,肺部并发症1.6%,一过性神经损害0.5%,失血性休克1%）;随访期并发症发生率为3.6%（迟发感染0.5%,内固定松动断裂1%,矫形显著丢失或畸形加重1.6%,一过性神经损害0.5%）。与文献报道的钩棒系统比较,围手术期并发症发生率低、矫形丢失不显著、永久性损害少、内固定相关并发症发生率低。 结论：后路钉棒系统治疗各种脊柱侧凸畸形并发症发生率低,熟练掌握椎弓根螺钉技术并熟悉椎弓根及其邻近组织的解剖,同时进行术中脊髓功能监护,能有效地防治椎弓根螺钉技术治疗胸椎脊柱侧凸畸形并发症的发生。     

凹侧双棒全椎弓根螺钉治疗重度僵硬性特发性脊柱侧凸的围手术期护理

目的 总结重度僵硬性特发性脊柱侧凸患者行凹侧双棒全椎弓根螺钉治疗的围手术期护理要点.方法 对37例需行凹侧双棒全椎弓根螺钉技术的重度僵硬性特发性脊柱侧凸患者进行术前心理护理、肺功能锻炼、主动锻炼及术前饮食指导,术后病情观察、防止并发症的综合护理干预措施.结果 本组均顺利完成手术,手术疗效显著,未出现严重护理并发症.结论 对行凹侧双棒全椎弓根螺钉技术的重度僵硬性特发性脊柱侧凸患者的每一个环节进行对症护理,效果显著.     

Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients： a Comparison of All Pedicle Screws versus Hybrid Instrumentation

Objective To analyze the influence of segmental pedicle screws versus hybrid instrumentation on the correction results in adolescent idiopathic scoliosis patients undergoing posterior selective thoracic fusion. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent selective thoracic fusion from February 2000 to January 2007 in our hospital, the patients were divided into 2 groups according to different instrumentation fashions： Group A was hook-screw-rod （hybrid） internal fixation type, Group B was screw-rod （all pedicle screws） internal fixation type, and the screws were used in every segment on the concave side of the thoracic curve. The parameters of the scoliosis were measured and the correction results were analyzed. Results Totally, 48 patients （7 males, 41 females） were included, with an average age of 14.4 years old and a mean follow-up time of 12.3 months. Thirty and 18 patients were assigned to group A and group B, respectively. The mean preoperative coronal Cobb angles of the thoracic curve were 48.8° and 47.4°, respectively. After surgery, they were corrected to 13.7° and 6.8°, respectively. At final follow-up, they were 17.0° and 9.5°, with an average correction rate of 64.6% and 79.0%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The mean preoperative coronal Cobb angles of the lumbar curve were 32.6° and 35.2°, respectively. After surgery, they were corrected to 8.6° and 8.3°, respectively. At final follow-up, they were 10.3° and 11.1°, with an average correction rate of 66.8% and 69.9%, respectively, and the correction rate of group B was significantly higher than that of group A （P=0.003）. The correction loss of the thoracic curve and lumbar curve in the 2 groups were 3.1° and 1.8°, 2.4° and 2.4°, respectively. No significant difference was noted （both P〉0.05）. The decompensation rate at final follow-up in these 2 groups were 4% （1/25） and 7.1% （1/14） respectively, with no significant difference （P〉0.05）.     

后路矫形侧连续置钉矫形结合n-HA/PA66人工骨粒植骨治疗青少年特发性脊柱侧凸

目的:讨论后路矫形侧连续置入椎弓根螺钉矫形、结合n-HA/PA66人工骨粒植骨治疗青少年特发性脊柱侧凸(Adolescent idiopathic scoliosis,AIS)的临床疗效.方法:回顾性分析2007年7月至2010年7月,收治的AIS患者21例,其中男6例,女15例;年龄12~20岁,平均15.2岁;主弯Cobb 角为40°~63°,平均为51.4°.本组患者的Lenke分型:Ⅰ型10例,Ⅱ型5例,Ⅲ型4例,Ⅳ型1例,Ⅴ型1例.21例患者均采用经后路矫形侧连续置入椎弓根钉矫形内固定、n-HA/PA66人工骨粒结合自体骨粒植骨融合术.结果:术后侧凸Cobb 角为5°~31°,平均13°,平均矫正率为79%,21例患者植骨后可获得良好的骨性融合,术后近期随访以及末次随访植骨融合率为93.4%,术后矫正率无明显丢失.患者可参加一般性体育锻炼,且均未出现内植物松动、断裂及其它相关并发症.结论:对于AIS患者,后路矫形侧连续置入椎弓根钉可获得满意的畸形矫正率,n-HA/PA66人工骨粒结合自体骨粒植骨可用于AIS患者的后外侧植骨融合.     

Lenke 2型特发性脊柱侧凸三维矫形手术的有限元模拟

目的 利用建立的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,分别仿真模拟前路、后路手术矫形操作,探讨其最佳手术方案。方法 建立Lenke 2型AIS的有限元模型,分别模拟前路和后路共5种不同的矫形方案,比较不同手术方案的矫形效果和双肩平衡参数的变化。结果 5种不同矫形方案有限元模拟术后的上胸弯冠状面Cobb角和矫形率分别为:21.5(44.8%)、26.5(32.1%)、28.1(27.9%)、34.1(12.5%)、32(17.9%),各矫形方案的主胸弯矫正率无明显差别。胸椎矢状面生理后凸得以维持。5种矫形方案术后各双肩平衡影像学参数较术前有所升高,除方案A(上端固定椎为T2)外,其余各方案的喙突高度差均＞9 mm,锁骨角均＞2.5°,锁骨倾斜角差均＞4.5°。结论 对于左肩高的含结构性上胸弯Lenke 2型AIS,上端固定椎选择T2且完全融合上胸弯,可取得上胸弯、主胸弯良好的三维矫形和双肩平衡。部分融合上胸弯(上端固定椎为T3、T4),上胸弯的矫正率稍差,术后容易出现轻度到中度双肩失平衡。前路或后路选择性胸主弯融合,难以恢复上胸弯的正常脊柱序列,术后会导致轻度到中度双肩失平衡。     

成人脊柱侧凸的手术治疗（附25例报告）

1983年10月至1937年5月，我院共收治各种类型的脊柱侧凸30例，除5例儿童采用保守治疗外，其余25例成年患者，均采用三种不同的内固定治疗：(1)单纯哈氏棒；(2)哈氏棒+钢丝，(3)啥氏棒+路克氏捧。现将治疗结果和存在问题进行分析。     

脊柱后路椎板减压、横突间植骨融合治疗老年腰椎管狭窄症的并发症

腰椎管狭窄症是导致老年人下腰痛的常见原因之一,自脊柱后路椎弓根内固定系统技术运用及发展以来,椎体固定及植骨融合均获得明显改善,但同时也带来了更多的并发症。现对我院2002年2月—2005年12月收治的146例老年性腰椎管狭窄症行脊柱后路椎板减压、经椎弓根螺钉脊柱内固定、横突间植骨融合的术中及术后并发症进行分析总结。     

“漏斗技术”置入胸椎椎弓根螺钉在青少年特发性脊柱侧弯矫形术中的应用

目的:探讨应用“漏斗技术”置入胸椎椎弓根螺钉,在青少年特发性脊柱侧弯(Adolescent idiopathic scoliosis,AIS)矫形手术中的实用性和安全性.方法:采用21例AIS,在手术矫形过程中,胸椎椎弓根螺钉的置入均采用“漏斗技术”,记录置入操作和术后并发症;对术中确信度不高的胸椎椎弓根置钉行三维C臂...     

后路脊柱融合术治疗青少年特发性脊柱侧凸的畸形相关并发症

青少年特发性脊柱侧凸(AIS)是一种发生于青春期累及脊柱三个平面的脊柱畸形,发病机制未明。后路脊柱融合术(PSF)是目前治疗AIS应用最广泛的术式,但其术后并发症也逐渐引起了人们的重视,其中,畸形相关并发症如adding-on现象、近端交界性后凸、远端交界处后凸、冠状位失衡和双肩不平衡是AIS术后最常见的并发症,了解这些并发症的定义、诊断标准、发生率、自然史、危险因素和预防措施对于制定AIS的手术策略至关重要。本文对近年来关于PSF治疗AIS出现畸形相关并发症的最新研究进展进行了概述。     

胸腰段青少年特发性脊柱侧凸远端融合椎选择的分析研究

目的 探讨胸腰段青少年特发性脊柱侧凸(AIS)远端融合椎(LIV)新的选择标准.方法 纳入融合胸腰弯且经过1.5年以上随访的患者52例,患者均符合新的AIS选择标准,即术前站立正位X线片骶正中线(CSVL)在侧凸远端接触到的第1椎体为触及椎(TV),且该TV应符合以下要求:Nash-Moe旋转度小于或等于Ⅱ度;凹侧Bending像上CSVL位于TV两侧椎弓根之间;不存在胸腰段及腰段后凸畸形;CSVL距离TV 3～4 mm的患者也列入研究范围.所有患者均由同一组经验丰富的脊柱外科医师实施手术,均采用后路全椎弓根钉内固定矫形融合.术前、术后即刻、终末随访均测站立位脊柱全长正侧X线片、卧位左右Bending像,并测量主弯Cobb角、冠状面躯干偏移(TS)、LIV倾斜度(LIVT)、LIV尾侧椎间盘角度(LIVA),观察TV、稳定椎等位置,记录并进行统计分析.结果 所有患者均随访18个月以上,平均(23±3)个月.术前、术后即刻、末次随访主弯Cobb角分别为(49.32±11.37)°、(9.08±6.78)°、(10.65±6.68)°,LIVT分为(21.76±4.68)°、(5.17±4.09)°、(5.16±3.08)°,LIVA分别为(7.19±5.16)°、(3.16±2.78)°、(4.17±3.28)°,术后即刻、末次随访时上述各项指标与术前比较,差异均有统计学意义(P＜0.05).术前躯干失代偿患者27例,末次随访时5例患者并发躯干失代偿,未较术前增加.将TV作为LIV与采用稳定椎做LIV相比,前者可以节省(1.42±0.45)个融合节段.结论 采用新标准进行胸腰段AIS手术治疗比目前临床上常用的方法节省融合节段.     

Strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction for the treatment of severe adolescent idiopathic scoliosis

Background  Many investigators advocate anterior release combined with halo-femoral traction and posterior fusion when treating stiff thoracic curves in patient with adolescent idiopathic scoliosis (AIS). But the anterior operations often induce severe complications. Some surgeons choose posterior-only surgery with halo-femoral traction, posterior wide release and correction. But to the best of our knowledge, there are only rare prospective studies on these posterior-only surgeries for AIS patients who have a rigid curve more than 80° and flexibility less than 35%.

Methods  Sixty-four AIS patients were recruited from September 2006 to June 2009. All patients had rigid curves and underwent spinal correction. They were randomly divided into group A (combined anteroposterior surgery) and group B (posterior-only surgery). Images and scoliosis research society-22 questionnaire (SRS-22) scores were performed pre- and post-operation and during follow-up visits. The operation time, blood loss, hospital days, and hospital charges were compared between the two groups.

Results  These patients were followed for an average of 37.5 months (range, 24–65 months). No serious complications were observed. There were no significant differences between the two groups in gender, age, preoperative radiographic data, or preoperative SRS-22 score. The average operation time, blood loss, hospital days and hospital charges in group B were less than those in group A. The SRS-22 score in group B was better than in group A at post-operation and at final follow-up.

Conclusions  In AIS with a rigid curve more than 80° and flexibility less than 35%, strong halo-femoral traction with wide posterior spinal release and three dimensional spinal correction can provide better SRS-22 scores, comparable curve correction, shorter operation time, less blood loss, shorter hospital stays and lower charges when compared to combined anterior and posterior surgery.

     

颅底凹陷症合并寰枢椎脱位手术治疗体会(附8例报告)

目的 介绍8例颅底凹陷症合并寰枢椎脱位颈枕后路钉棒系统辅助下齿状突复位的技术要点及临床效果。方法 2010年1月至2013年5月收治颅底凹陷症合并寰枢椎脱位患者8例,所有患者都选用强生公司钉棒系统、Y型枕骨板和钛棒,其中行双侧C2椎弓根螺钉固定4例,行双侧C2椎弓根螺钉及双侧C3侧块螺钉固定3例,行右侧C2椎弓根螺钉、左侧C3侧块螺钉及双侧C4侧块螺钉固定1例。术前后均行X光片、CT扫描观察齿状突复位效果及螺钉位置, 通过比较术前术后钱氏线( CL)、寰椎齿突间隙(ADI)和延髓脊髓夹角(CMA), 评价手术疗效。结果 8例患者中手术后齿状突均达到不同程度的复位,CT复查螺钉位置理想,所有病例均形成良好骨性融合。随访2~40个月, 所有患者术前肢体麻木、无力等症状较术前明显好转,1例患者术后出现吞咽固体食物困难,对症治疗1月后好转。结论 颈枕后路钉棒植入并撑开技术可以有效地治疗颅底凹陷合并寰枢椎脱位,解除齿状突脱位导致的压迫症状。