前路Moss Miami器械矫形治疗特发性胸腰段或腰段脊柱侧凸

目的:评价MossMiami前路矫形系统对特发性胸腰段或腰段脊柱侧凸的手术效果。方法:对21例胸腰段或腰段特发性脊柱侧凸患者经前路胸腹联合入路行MossMiami矫形内固定,自体肋骨椎间植骨融合术。测量手术前后Cobb角以及躯干侧方位移。结果:Cobb角术前平均53°,术后平均5°,矫正率为90%。上方代偿性胸椎侧凸术前平均17°,术后矫正至平均5°。下方代偿性腰骶椎侧凸术前平均43°,术后自发矫正至19°。随访12~24个月,Cobb角平均丢失19.7°,胸腰段(T11~L1)术前平均前凸0.3°(0~4°),术后平均后凸3°(0~5°)。躯干侧方位移从术前平均26mm矫正至术后5mm。1例术后出现一侧下肢交感神经切断症状,2例术后并发气胸。无感染、截瘫及内固定失败等并发症发生。结论:MossMiami前路器械具有操作简单和低切迹的优点。棒的预弯、去旋转矫形、正确选择螺钉置入部位和椎间植骨可防止固定节段后凸畸形的形成。对Risser征小于4度的患者应密切观察上方代偿性胸椎侧凸进展情况。     

胸腔镜下前路松解联合后路矫形治疗脊柱畸形

目的:评价胸腔镜下前路松解联合后路矫形对脊柱畸形的治疗效果。方法:回顾性分析我院收治的19例脊柱畸形行胸腔镜辅助前路松解及后路脊柱畸形矫形植骨融合术患者的临床资料及治疗结果。结果:胸腔镜手术时间平均120min,前路松解、阻滞椎间盘平均4.2个。术后14例特发性脊柱侧凸Cobb角平均被纠正到29.4°,4例神经纤维瘤病性脊柱侧凸Cobb角平均被纠正到28°,1例胸椎后凸Cobb角被纠正到58.5°。术后平均随访17.5个月,无矫正度的丢失和其它神经系统及血管损伤并发症。结论:胸腔镜辅助前路脊柱松解是安全、有效的微创手术,联合后路矫形治疗脊柱畸形可获得满意治疗效果。     

钛网椎间融合器在脊柱侧凸前路矫形矢状面形态维持中作用的初步研究

目的探讨钛网椎间融合器在脊柱侧凸前路矫形中应用的作用、效果及意义。方法对36例胸腰椎或腰椎特发性脊柱侧凸患者行前路手术,在矫形过程中在固定节段的每个椎间隙分别置入单个钛网椎间融合器。其中男性5例,女性31例,年龄14～22岁(平均17岁)。结果患者术前、术后及术后平均随访13个月的侧凸Cobb角分别为56°、15°和18°,胸椎后凸Cobb角分别为30°、33°和37°,腰椎前凸(L1～S1)Cobb角分别为46°、56°和51°。无死亡,无感染,无椎间隙塌陷。术中肉眼下乳糜管损伤1例(予以结扎),术后渗出性胸膜炎1例,两下肢短期皮温不等3例,胸腔积液2例(其中1例行穿刺引流)。结论在脊柱侧凸前路矫形中应用钛网椎间融合器可以达到很好的冠状面和矢状面的矫正,并可有效防止椎间隙的塌陷和防止腰椎后凸的形成。     

电视辅助胸腔镜下脊柱侧凸矫形融合术

目的:探讨电视辅助胸腔镜下脊柱侧凸矫形融合术的操作技术和初期临床结果。方法:回顾性分析我院2003年3月至2004年1月完成的10例胸腔镜下Eclipse矫形融合术病例,特发性脊柱侧凸9例,先天性脊柱侧凸1例,年龄11￣17岁,平均13.3岁。对手术前后及随访时冠状面和矢状面Cobb角进行测量,并对手术时间、术中出血量、围手术期并发症及初步矫形效果进行分析。结果:手术时间平均6.5h,固定融合节段5￣7个(平均6.3个)椎体,每一节段手术时间0.75￣1.70h(平均1.1h),手术总失血量200～600ml(平均360ml)。手术前后主胸弯冠状面Cobb角分别为44.0°和16.4°,手术矫形率63.2%;手术前后腰弯冠状面Cobb角分别为29.0°和12.9°,自动矫形率54.4%。随访6￣24个月,平均14.7月,随访时胸、腰弯冠状面Cobb角分别为20.1°和19.6°,分别丢失3.7°和6.7°。手术前后主胸弯的顶椎偏距分别为28.6mm和9.6mm,腰弯的顶椎偏距分别为14.1mm和8.6mm。手术前后矢状面上胸后凸的Cobb角分别为12.3°和23.9°。结论:电视辅助胸腔镜下脊柱侧凸矫形融合术具有创伤小,出血少和小切口美容效果,对轻中度侧凸可获得良好矫形效果,但矫形容易丢失。     

支点弯曲位X线片预测脊柱侧凸三维矫形效果的价值

目的:评价支点弯曲位X线片在预测特发性脊柱侧凸患者脊柱矫形融合术效果的价值。方法:对37例特发性脊柱侧凸患者的43个结构性弯曲行术前站立位﹑仰卧侧屈位和支点弯曲位X线摄片,并与术后一周的站立位X线片比较。测量所有Cobb角并进行统计学评价。结果:胸弯组和腰弯组仰卧侧屈位平均Cobb角分别为43°和22°,支点弯曲位平均Cobb角分别为38°和19°,术后Cobb角分别为37°和19°。前路手术组和后路手术组仰卧侧屈位平均Cobb角分别为47°和13°,支点弯曲位平均Cobb角分别为42°和9°,术后Cobb角分别为41°和9°。严重侧弯组和中度侧弯组仰卧侧屈位平均Cobb角分别为52°和22°,支点弯曲位平均Cobb角分别为49°和19°,术后Cobb角分别为45°和20°。僵硬侧弯组和柔软侧弯组仰卧侧屈位平均Cobb角分别为51°和22°,支点弯曲位平均Cobb角分别为48°和17°,术后Cobb角分别为43°和19°。结论:支点弯曲位X线片比传统摄片能更好地评估特发性脊柱侧凸患者在脊柱矫形融合术中所获得的矫正效果,但对严重或较僵硬的侧凸矫形效果预测较差。     

新型滑槽钉生长棒内固定系统治疗儿童脊柱侧凸的初步报告

 目的 评价新型滑槽钉生长棒内固定系统在儿童脊柱侧凸治疗中的初步临床疗效。 方法 自2009年1月至2011年7月,使用滑槽钉生长棒内固定系统治疗脊柱侧凸患儿10例,男3例,女7例;年龄4～12岁,平均7.8岁。Risser征均为0级。均为特发性脊柱侧凸。单胸弯3例,单胸腰弯或腰弯6例,双胸弯1例。入院时冠状位Cobb角38°~85°,平均66.8°;矢状位Cobb角38°~66°,平均45.5°;坐高36~64 cm,平均48.6 cm。疗效评价指标包括冠状位、矢状位Cobb角及其矫正率、坐高、躯干偏移、双肩高度差、植骨融合情况、矫正丢失率和并发症,重点在身高和发育情况。结果 术后即刻冠状位Cobb角17°~39°,平均28°,矫正率为48%～65%,平均为52%。术后矢状位Cobb角25°~39°,平均31°,坐高46~70 cm,平均56.8 cm。全部病例随访12～44个月,平均26.5个月。随访期间矫正角度丢失率＜ 5%,坐高平均增加2 cm ,3例出现矫形棒尾端皮肤感染,均予以局部换药后痊愈,1例术后出现肩部失平衡,余未出现断钉、断棒等内固定相关并发症。结论 新型滑槽钉生长棒内固定系统治疗儿童脊柱侧凸的初步临床疗效证实该系统的有效性和安全性。     

胸腔镜辅助下治疗特发性脊柱侧凸

[目的]评价胸腔镜下前路松解,前路或后路矫形治疗特发性脊柱侧凸的治疗效果。[方法]回顾本院自2003年7月~2005年12月施行的11例胸腔镜辅助下前路松解,前路或后路矫形治疗特发性脊柱侧凸病例。年龄12~16岁,平均14.6岁。LenkeⅠ型9例,术前冠状面Cobb s角54°~68°,平均59.7°;LenkeⅢ型2例,术前冠状面Cobb s角分别为58°和71°,平均64.5°。Bending X线片侧凸矫正率为21.8%~32.4%,平均26.4%。对11例患者在胸腔镜辅助下,采用等离子冷消融切除椎间盘松解,前或后路矫正。对手术后及随访时,冠状面和矢状面的Cobb s角进行测量,并对手术时间,术中出血量,围手术期并发症及矫正丢失等进行分析。[结果]平均手术时间290 min,平均术中出血171 ml。松解节段5~7个,平均4.4个。9例LenkeⅠ型术后Cobb s角平均20.4°,Cobb s角矫正率平均65.8%;2例LenkeⅢ型术后Cobb s角分别为20°和25°,Cobb s角矫正率平均65.1%;1例术后包裹性胸腔积液,术后平均随访18.6个月;1例出现矫正度丢失14°,无神经系统及血管损伤并发症。[结论]与传统开胸前路胸椎侧凸矫形手术相比,胸腔镜辅助下胸椎松解前后路矫形治疗脊柱侧凸是安全有效的微创手术,可达到与开胸手术同样效果。     

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.     

应用CD三维矫形系统治疗脊柱侧凸

目的 :观察应用CD三维矫形系统矫正脊柱侧凸的冠状面、矢状面和轴面三维畸形的临床疗效。方法 :1 996年 6月～ 2 0 0 0年 6月应用CD系统矫治脊柱侧凸 35例 ,其中先天性脊柱侧凸 1 0例 ,特发性脊柱侧凸 2 5例。术前冠状面侧凸Cobb角 45°～ 90°,平均65° ;矢状面脊柱后凸Cobb法 - 1 2°～ 61°,平均 47.5°;旋转畸形Nash Moe法为Ⅰ～Ⅲ度。结果 :术后经 1～ 4年 ,平均 2年随访 ,冠状面畸形为 1 0°～ 45° ,平均 2 4 .5°,平均矫正率为 61 .6 % ;矢状面胸椎后凸 2 0°～ 35°,平均 2 7°,旋转畸形矫正 1度 ,无严重并发症发生。结论 :CD系统具有三维矫形能力 ,矫正效果好 ,固定牢固可靠 ,并发症少     

青少年特发性脊柱侧凸后路矫形术后 新发上胸弯转归分析

  目的 对术前无上胸弯的青少年特发性脊柱侧凸患者行后路矫形手术后新发上胸弯的情 况进行转归分析。 方法回顾性分析21 例患者的影像学资料, 平均随访时间19.8 个月, 对新发上胸弯 的冠状面Cobb 角、T1倾斜、放射学肩高度等影像学参数进行测量与分析。 结果 21 例患者术前主胸弯 冠状面Cobb 角平均为54.3°, 末次随访时平均为14.1°, 手术矫形率平均为74.6豫。术前5 例患者为负性 T1倾斜, 16 例为T1水平;术后均出现正性T1倾斜及新发上胸弯, T1倾斜平均6.0°, 新发上胸弯冠状面 Cobb 角平均为16.0°;末次随访时T1倾斜平均4.0°, 上胸弯平均为13.2°, 18 例患者仍存在正性T1倾斜, 17 例患者仍存在10°以上的上胸弯。术前5例患者放射学肩高度为双肩等高, 16 例为右肩高;术后19 例患者为左肩高, 6 例患者存在双肩不平衡;末次随访时有14 例患者为左肩高, 5 例患者存在双肩不平 衡。末次随访时与术后相比, T1倾斜程度、上胸弯冠状面Cobb 角均有改善(t=2.755, P=0.009;t=2.142, P= 0.038), 但上胸弯比例、左肩高发生率、双肩失平衡发生率差异均无统计学意义(χ²=4.421, P=0.107;χ²= 0.123, P=1.000;χ²=3.535, P=0.130)。 结论 青少年特发性脊柱侧凸患者后路手术矫形时新发上胸弯不易 自行代偿, 且易对双肩平衡产生影响, 应以预防其发生为主。     

脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告

目的探讨采用以脊柱前方垫高后方闭合为技术特征的新型脊柱截骨矫形术治疗胸腰段脊柱后凸畸形的可行性、安全性和有效性。方法自2003年以来,采用新型脊柱截骨矫形术治疗不同病因所致的胸腰段脊柱后凸畸形8例。其中男、女各4例,年龄14～58岁,平均35岁。术前脊柱后凸Cobb角平均为73°(42°～90°),3例合并脊柱侧凸的Cobb角平均为25.7°。术前Frankel分级:C级2例、D级2例、E级4例。8例均伴有较为严重的胸腰背部疼痛,3例伴有膀胱括约肌功能障碍。手术方式均为:单纯后路经双侧关节突关节、椎间隙楔性截骨,切断前纵韧带,先行脊柱前方撑开垫高(将椎间融合器植入椎间截骨面),再行脊柱后方加压闭合及椎弓根螺钉器械固定。结果平均手术时间4.5h(3.5～6.0h),平均术中出血量2280ml(700～4200ml)。术中有1例血压曾一度偏低,术后脑脊液漏1例,此外无其他手术并发症发生。术后脊柱后凸Cobb角平均为8.3°、平均矫正度数为64.7°、平均矫正率为88.6%;术后脊柱侧凸Cobb角平均为18.7°、平均矫正度数为7°、平均矫正率为27.2%。术后平均随访12.8个月(5～23个月),X线片可见原截骨平面均已发生骨性融合,胸腰背部疼痛症状完全消失。术后Frankel分级:C级1例、D级2例、E级5例;3例膀胱括约肌功能障碍者中2例术后症状有改善。结论与现行常用的单纯闭合楔形截骨术式相比,新型脊柱截骨矫形术可有效地避免脊柱过度短缩和脊髓扭曲、折皱的发生,提高了脊柱闭合截骨的安全性;同时也明显地提高了单一节段脊柱后凸畸形的安全截骨矫正度数。可适用于40°～90°的胸腰段脊柱后凸畸形的手术治疗。     

Mini-open anterior instrumentation with diaphragm sparing for thoracolumbar idiopathic scoliosis: its technique and clinical results

The traditional method of thoracoabdominal retroperitoneal approach requires dissection of diaphragm which bears potential complications such as postoperatively weakened abdominal breathing and dysfunction of diaphragm. Mini-open anterior instrumentation with diaphragm sparing is designed to minimize the damage to diaphragm and improve cosmesis. This study compared the traditional anterior instrumentation and mini-open anterior instrumentation under the hypothesis that both results in similar surgical outcomes in treating thoracolumbar scoliosis. In Group A, 38 patients with an average age of 16.5 years underwent mini-open anterior instrumentation with diaphragm sparing. The average standing coronal Cobb angle was 56.4° in Group A. Thirty-eight patients with average age of 16.7 years in Group B received traditional open approach. The preoperative average Cobb angle was 55.8° in Group B. The average correction rate of coronal curve was 78% in group A while 75% in group B. No statistical difference between the two groups in terms of coronal curve correction, sagittal profile restoration and estimated blood loss was observed. The operation time was significantly higher in Group A than that in Group B. All patients in the two groups had good healing of incisions without neurological and instrumental complications during minimal 2 year follow-up. In Groups A and B, two patients suffered from pleural effusion, respectively. The wedging of the vertebral discs distal to the lowest fused level occurred in three and four patients in Group A and B, respectively. One case in group B was found to be suspicious pseudoarthrosis without loss of correction. Mini-open anterior instrumentation with diaphragm sparing could minimize the surgical invasion as well as achieve similar clinical outcomes compared with classical anterior approach.     

特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的疗效比较

目的对特发性胸椎侧凸胸腔镜下前路矫形与开放小切口前路矫形的近期疗效进行比较。方法将23例特发性胸椎右侧凸患者分为两组,A组行胸腔镜下胸椎侧凸前路Eclipse矫形术,共8例,均为女性,平均年龄148岁,平均Cobb角54°,Risser征 ～ 。B组行开放小切口前路CDHTSRH矫形手术,共15例,男2例,女13例,平均年龄138岁,Cobb角平均57°,Risser征 ～ 。对两组病例的手术时间、术中出血量、固定节段、术后引流量、矫正效果以及早期矫正丢失等进行分析。结果两组患者在年龄、Cobb角、侧凸柔软性和固定节段等方面均具有可比性。A组平均手术时间(360±72)min,术中平均出血量(629±145)ml,术后平均引流量(500±150)ml,平均固定节段(74±11)个,平均Cobb角矫正率(74±14)%,经6～18个月随访,近期矫正丢失率(86±27)%。B组平均手术时间(246±64)min,术中平均出血量(300±110)ml,术后平均引流量(210±90)ml,平均固定节段(78±09)个,平均Cobb角矫正率(70±12)%,近期矫正丢失率(46±19)%。A组与B组相比,侧凸矫正率相似(P>005),但手术时间、术中出血量、术后引流量,以及早期矫正丢失率等存在显著差异(P<005)。结论胸腔镜下胸椎侧凸前路矫形手术和开放小切口前路矫形手术具有各自的适应证和优缺点。对于青少年特发性胸椎侧凸     

Radiographic evaluation of selective anterior thoracolumbar or lumbar fusion for adolescent idiopathic scoliosis

According to Lenke classification of adolescent idiopathic scoliosis (AIS), patients with type 5 curve in which the structural major curve is thoracolumbar or lumbar curve with nonstructural proximal thoracic and main thoracic curves, could be surgically treated with selective anterior thoracolumbar or lumbar (TL/L) fusion. This study retrospectively analyzed the radiographies of selective anterior TL/L fusion in 35 cases of AIS with Lenke type 5 curve. Segmental fixation with a single rigid rod through anterior thoracoabdominal approach was applied in all patients. Measurements of scoliosis curve in preoperative, immediate postoperative and follow-up radiographies were analyzed. The average follow up time was 36 months (24-42 months). The average preoperative Cobb angle of the TL/L curve was 45.6 degrees and improved into 9.7 degrees immediate postoperatively, with 79.7% curve correction. In addition, the minor thoracic curve decreased from 29.7 degrees preoperatively to 17.6 degrees postoperatively, with a spontaneous correction of 41.5%. During the follow-up, a loss of 4.6 degrees correction was found and the average Cobb angle of TL/L increased to 14.4 degrees . Also, the minor thoracic curve increased to average 20.1 degrees with a loss of 2.4 degrees correction. Trunk shift deteriorated slightly immediate postoperatively and improved at the follow-up. The lowest instrumented vertebra (LIV) tilt was improved significantly and maintained its results at the follow-up. During the follow-up, the coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) aggravated, while the sagittal contours of T5-T12 and T10-L2 were well maintained. The lumbar lordosis of L1-S1 and the sagittal Cobb angle of the instrumented segments were reduced slightly postoperatively and at the follow-up. There were no major complications or pseudarthrosis. The outcomes of this study show that selective anterior thoracolumbar or lumbar fusion with solid rod instrumentation is effective for surgical correction of AIS with Lenke type 5 curve. The TL/L curve, minor thoracic curve, and LIV title can be improved significantly, with good maintenance of sagittal contour. However, the UIVDA and LIVDA aggravate postoperatively when the trunk rebalances itself during follow-up. The degeneration of LIV disc warrants longer-term follow-up.     

Maintaining lumbar lordosis with anterior single solid-rod instrumentation in thoracolumbar and lumbar adolescent idiopathic scoliosis.

STUDY DESIGN: A prospective radiographic evaluation of 20 consecutive patients with primary lumbar or thoracolumbar adolescent idiopathic scoliosis who were treated with anterior convex compressive single solid-rod spinal instrumentation and structural titanium mesh (Harms) cages. OBJECTIVES: To evaluate a lordosis-preserving anterior single solid-rod instrumented fusion technique for these specific adolescent idiopathic curves. SUMMARY OF BACKGROUND DATA: Maintaining instrumented segmental lumbar lordosis after anterior fusion and instrumentation for thoracolumbar and lumbar curves has been difficult. Twenty consecutive patients who underwent anterior single solid-rod fusion, aged 18 or younger with a primary thoracolumbar or lumbar curve, were observed for preservation of lordosis for a minimum of 2 years. METHODS: All patients underwent an identical anterior surgical technique, involving discectomies and anulectomies of all convex discs, structural titanium mesh (Harms) cages placed in the anterior half of all disc spaces below T12, morselized rib autograft packed in all disc spaces to be fused and inside the cages, and anterior single solid-rod (5.0-mm or 5.5-mm diameter) convex compressive spinal instrumentation with appropriate lordotic rod contour and rod rotation as necessary. The anterior rod was placed just posterior to the cages to optimize lordotic contouring of the spine during compression. None of the patients was braced after surgery. The lowest instrumented vertebrae (LIV) were L2 (n = 3), L3 (n = 15), and L4 (n = 2), typically the lower end vertebra of the Cobb measurement. RESULTS: Measurements for the primary coronal Cobb before surgery, 1 week after surgery, and 2 years after surgery were 48 degrees, 11 degrees, and 12 degrees; for C7 plumb line deviation from the midline: 3.6 cm, 1.9 cm, and 1.2 cm; for lowest instrumented vertebra translation: 31 mm, 15 mm, and 15 mm; and for LIV tilt: 29 degrees, 6 degrees and 6 degrees, respectively. Sagittal measurements before surgery, 1 week after surgery, and 2 years after surgery were: T12-L2: -1 degree, -6 degrees, and -6 degrees; T12-LIV: -8 degrees, -13 degrees, -9 degrees; T12-S1: -61 degrees, -56 degrees, -60 degrees; and entire instrumented levels: -6 degrees, -9 degrees, and -6 degrees, respectively. Coronal plane correction improved: 75% in the primary Cobb, 66% in the plumb line, 50% in LIV translation, and 80% in LIV tilt. Sagittal plane alignment improved in T12-L2 lordosis (P < 0.01) with preservation of physiologic lordosis in the instrumented levels, T12-LIV, and T12-sacrum. There were no instrumentation failures, pseudarthroses, or reoperations. CONCLUSIONS: Coronal plane correction with preservation of thoracolumbar and lumbar lordosis 2 years after anterior convex compressive spinal instrumentation was accomplished using a lordotically contoured single solid rod with structural cages placed anteriorly in the disc spaces of patients with primary thoracolumbar or lumbar adolescent idiopathic scoliosis.     

Scoliosis correction maintenance in skeletally immature patients with idiopathic scoliosis. Is anterior fusion really necessary?

STUDY DESIGN: A retrospective evaluation of the occurrence of the crankshaft phenomenon in skeletally immature patients with idiopathic scoliosis. OBJECTIVE: To determine what factors, if any, contribute to a decreased occurrence of crankshaft phenomenon in patients treated with posterior surgery only. SUMMARY OF BACKGROUND DATA: Reports have described the progression of scoliotic deformity, termed the crankshaft phenomenon, in a region of solid posterior arthrodesis in skeletally immature patients. This has led some authors to advocate the use of concomitant anterior discectomy and fusion to prevent crankshaft. METHODS: From 1989 through 1994, 18 Risser 0 patients with thoracic or thoracolumbar idiopathic scoliosis underwent Isola (De Puy-Acromed, Raynham, MA) posterior instrumentation and fusion. They were assessed for evidence of the crankshaft phenomenon, identified by coronal plane deformity progression of 10 degrees or more, or a rib vertebra angle difference of 10 degrees or more. The average age of the patients was 12.5 years (range, 10.5-15.5 years), and the average follow-up period was 39 months (range, 24-68 months). RESULTS: Eleven patients (10 girls and 1 boy) had closed triradiate cartilage at the time of surgery. Their average Cobb angle was 62 degrees before surgery, 21 degrees after surgery, and 22 degrees at follow-up assessment. No patients in this group met the criteria for crankshaft. Seven patients (6 girls and 1 boy) had open triradiate cartilage at the time of surgery. Their average Cobb angle was 62 degrees before surgery, 18 degrees after surgery, and 20 degrees at follow-up evaluation. No patient had a 10 degrees or more increase in rib vertebra angle difference. One patient had more than a 10 degrees increase in her Cobb angle (11 degrees) from postoperative to latest follow-up assessment. Her instrumentation construct, performed in 1989, used sublaminar wires as the caudal anchors. Hooks and pedicle screws are now used. Two of the seven patients with open triradiate cartilage underwent surgery during or before their peak height velocity and displayed no evidence of crankshaft. No deaths, neurologic complications, or infections occurred in either group. CONCLUSIONS: These findings suggest that scoliotic deformity progression can be prevented in skeletally immature patients with idiopathic scoliosis as young as 10 years of age with the use of stiff segmental posterior instrumentation, without the necessity of concomitant anterior arthrodesis.     

改良PSO截骨治疗成人特发性僵硬性脊柱侧弯

目的：评价经后路改良PSO截骨治疗成人特发性僵硬性脊柱侧弯的安全性及早期临床疗效。方法2009-05-2012-04采用经后路顶椎区改良PSO截骨、凸侧部分肋骨头颈段切除及椎弓根螺钉固定矫正治疗成人特发性僵硬性脊柱侧弯患者17例。测量患者术前术后X线片冠状面及矢状面Cobb角, C7中垂线与骶骨中垂线距离,C7铅垂线与骶骨后上缘间的水平距离（SVA间距）以及身高指标来评价侧后凸畸形的纠正和植骨融合情况。结果后凸Cobb角术前平均为50°,术后15°;侧凸Cobb角术前平均为90°,术后18°;C7中垂线与骶骨中垂线距离术前平均4.2 cm,术后0.7 cm;SVA间距术前平均4.1 cm,术后1.5 cm。术前术后比较差异均有统计学意义（P〈0.01）。结论经后路改良PSO截骨、椎弓根螺钉固定矫正治疗成人特发性僵硬性脊柱侧弯,能有效矫正畸形和恢复脊柱冠、矢状面平衡,早期结果令人满意。     

Vertebral decancellation for severe scoliosis

STUDY DESIGN: The results of staged surgery including vertebral decancellation were reviewed retrospectively for 21 patients with severe scoliosis. OBJECTIVES: To evaluate the benefits and limitations of vertebral decancellation as new anterior surgical procedure. SUMMARY OF BACKGROUND DATA: The curvatures of severe scoliosis are often very rigid, and surgical correction using the anterior or posterior approach may not achieve the desired correction. Some studies reported neurologic complications might appear due to the aggressive approach or excessive correction force. METHODS: Twenty-one patients (average age, 17.0 years) with severe scoliosis, in whom Cobb angle was over 80 degrees (average angle, 107 degrees), underwent staged anterior and posterior spinal reconstruction. Vertebral decancellation was performed as anterior procedure, and until posterior instrumentation, halo traction was carried out. The transition of curvatures in coronal and sagittal planes was assessed in this series. RESULTS: The average correction rate of lateral curvature at the final follow-up was 46%. The average loss of correction was 2.5 degrees. Kyphosis, measured between T5 and T12, changed from 41 degrees to 36 degrees. Lordosis, measured between L1 and S1, changed from 56 degrees to 45 degrees. Transient neurologic deficit was seen in one case after vertebral decancellation. CONCLUSIONS: Staged surgery including vertebral decancellation is an effective surgical method for patients with severe scoliosis, where an inflexible rigid curve or the risk of occurrence of neurologic complications due to temporary correction may exist.     

Scanning stereographic surface measurement in idiopathic scoliosis after VDS (ventral derotation spondylodesis)

INTRODUCTION: So far only radiometric and clinical methods have been available for the evaluation of results after anterior scoliosis surgery. Rasterstereography has proved to be a reliable method for three-dimensional surface measurement of conservatively treated idiopathic scoliosis patients. Therefore, patients treated operatively with anterior instrumentation were examined using rasterstereography to determine the three-dimensional correction of the spinal deformity. The aim was to measure back shape deformity, in particular derotation, and thus cosmetic improvements. METHODS: 31 patients with idiopathic thoracic, thoracolumbar and lumbar scoliosis (Cobb angle 57.2 degrees) were examined with raster stereography preoperatively, postoperatively and after follow-up (25.2 months) in a standardized standing posture. Standing radiographs were compared with raster stereography. RESULTS: The mean Cobb angle was reduced from 57.2 degrees to 17.2 degrees, the rasterstereographic maximal surface rotation from 16.5 degrees to 10.8 degrees, and the vertebral rotation according to Perdriolle from 29.2 degrees to 16.7 degrees. During follow-up the Cobb angle increased to 20.8 degrees, and surface rotation to 11.3 degrees. Vertebral rotation remained constant. Lordosis and kyphosis angles changed only slightly. CONCLUSION: Rasterstereography is a suitable tool for analyzing the three-dimensional correction of spinal deformities after anterior scoliosis surgery. In particular, the cosmetic improvement is clearly demonstrated. The measurement of surface rotation allows objective quantification of the obtained derotation.