ISOLA器械治疗小儿脊柱侧凸

目的定期随访评价ISOLA器械治疗小儿脊柱侧凸.方法41例小儿脊柱侧凸患儿,特发性脊柱侧凸32例,神经肌肉性脊柱侧凸5例,其他类型的脊柱侧凸4例,术前、术中、术后均摄X线片,记录Cobb角,顶椎的移位及旋转,躯干偏离中线程度.结果Cobb角术前平均为66°,术后1年为36°,术后2年为36°.1年后,所有患儿的脊柱均完全融合.顶椎的偏离改善了14mm.躯干偏离改善了5mm.特发性脊柱侧凸患儿1年后有基本的正常活动.术后4例出现并发症,1例深部感染,1例骶尾部褥疮,1例横钩脱落,1例L3椎弓根螺丝钉脱落.结论目前有多种后路器械治疗小儿脊柱侧凸.严格掌握手术指征及ISOLA的原理,该术式能获得较为满意的疗效.

Treatment outcomes of children scoliosis undergoing posterior instrumentation and fusion using ISOLA system

Objective To evaluate the treatment outcomes of children scoliosis by posterior spinal fusion with ISOLA instrumentation.Methods The clinical and radiographic data of 41 cases, including 32 with adolescent idiopathic scoliosis, 5 with neuromuscular scoliosis and 4 with miscellaneous scoliosis were reviewed retrospectively. Radiographic data included Cobb's angle, aped vertebral translation (AVT), aped vertebral rotation (AVR), and trunk shift (TF). Peri anaesthetic considerations include temperature maintenance, mean arterial blood pressure maintenance, positioning, and physiological and neurological monitoring. The posterior elements of the spine were exposed subperiosteally with removal of interspinous ligaments, posterior facet capsules, and superficial layers of the ligamentum flavea. ISOLA implants were divided into four major categories: anchor, longitudinal members, connectors, and accessories. With ISOLA implant, the goal is to correct angular spine deformity, maximize access to anchoring sites, to allow the use of supplemental devices necessary for the management of deformity, to minimize the need for external supports, and to preserve motion segments. Results Average of Cobb's angle before operation, 1 year after operation, 2 year after operation was 66.2 degree, 36 degree and 36 degree respectively. Fusion was achieved in all patients 1 year after operation. AVT improved by 14 mm, TF by 5?mm. AIS were in good trunk balance and share normal motivation as the same normal age children. Complication occurred in 4 cases, including 1 patient with deep wound infection, 1 with sacral bedsore, 1 with transverse hook dislodgment and 1 with lumber 3 pedicle screw pullout.Conclusions There are many treatments for posterior instrumentation and fusion. ISOLA could achieve good results on the conditions of careful patient selection, thorough preoperative planning, sound surgical principles and good surgical techniques. ISOLA can be one of option for treatment of children scoliosis.