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。

The effect of titanium mesh cage on maintenance of thoracolumbar and lumbar lordosis in anterior instrumentation for thoracolumbar and lumbar scoliosis

OBJECTIVE: To evaluate the clinical importance of titanium mesh cage (TMC) in anterior instrumentation for scoliosis. METHODS: Thirty-six consecutive patients with thoracolumbar/lumbar adolescent idiopathic scoliosis were treated with anterior derotation and instrumentation using autologous bone grafting and TMC for interbody fusion. The average age of patients was 17 years (ranged from 14 to 22 years), in which 5 cases were male and 31 cases were female. RESULTS: The coronal Cobb angle before surgery, 2 weeks after surgery, and 13 months at the follow-up was measured as 56 degrees , 15 degrees , and 18 degrees respectively, while the thoracic kyphosis from T(5) to T(12) was 30 degrees , 33 degrees , and 37 degrees respectively, and the lumbar lordosis from L(1) to S(1) was 46 degrees , 56 degrees , 51 degrees . There were no death, infection, implant failures or collapse of intervertebral space. Intraoperative injury of lacteal occurred in one patient, but no postoperative complications happened. One of two patients who had pleural effusion was managed with close drainage. Exudative pleurisy occurred in one patient, the sympathectomy effect occurred in three patients who presented asymmetry of skin temperature and resolved in short term. CONCLUSIONS: Coronal and sagittal alignment can be well corrected and maintained with TMC in anterior scoliosis surgery, collapse of intervertebral space and lumbar kyphosis can be prevented.