后路矫正特发性脊柱侧凸相关问题的探讨

目的探讨后路矫正特发性脊柱侧凸的相关问题。方法回顾2001年1月～2006年10月42例特发性脊柱侧凸患者，冠状面Cobb角45°～145°，平均76．75°；矢状面Cobb角22°～105°，平均47．08°；Bending相主胸弯侧凸平均矫正率20．51％～39．19％。侧凸Cobb角80°～145°8例，采用一期后路松解，颅盆环牵引二期后路选择性节段椎弓根螺钉固定及胸廓成形术；侧凸Cobb角60°～79°16例，行同期后路松解选择性节段椎弓根螺钉固定术；侧凸Cobb角小于60。18例，勿需松解，即行选择性节段椎弓根螺钉固定。结果Cobb角80°～145。、60°～79。和小于60。的术后矫正Cobb角分别为10°～40°（34．50°）、6°～25°（18．66。）、4°～18°（10．11°）；术后侧凸平均矫正率分别达66．88％、73．31％和80．34％。术后后凸Cobb角平均矫正角度为29．50°、27．74°和22．65°，平均矫正率分别为57．35％、40．77％和10．30％。随访12～78个月（平均36个月），16例失访，随访26例中23例内固定无松脱断裂，畸形丢失率为1．53％～5．10％，平均3．01％。2例术后1年半复查发现断棒，再次矫形术。结论重度AIS应采用后路广泛松解，凹侧松解是关键。颅盆环牵引安全可靠。选择性节段椎弓根螺钉固定同样达到全节段椎弓根螺钉固定的矫形效果。融合范围应密切结合AIS的分型。胸廓成形术后早期对肺功能有影响，通过术后肺功能训练可恢复至术前水平。

The treatment of idiopathic scoliosis with posterior surgery： What we should pay attention to？

Objective To discuss some issues regarding the efficacy of posterior surgery for idiopathic scoliosis. Methods This is a retrospective review of 42 patients with idiopathic scoliosis from Jan. 2001 to Oct, 2006. Average preoperative Cobb angle was 76.75° （range 45°- 145°）, average sagittal curve was 47.08° （range 22°- 105°）, and the flexibility as showed on bending film was 20.51%-39.19%. The patients were treated by three different methods of surgery： posterior release, skull-pelvic traction, selective pedicle screw fixation and thoracoplasty （n = 8, Cobb angle ranging 80° - 145°）, Posterior release and selective pedicle screw fixation （n = 16, Cobb angle ranging 60° - 79°） , and selective pedicle screw fixation （n = 18, Cobb angle ranging 〈60°）. Results Patients with average preoperative Cobb angle ranging 80°- 145°, 60°- 79°, 〈60° were corrected to 10° -40° （mean 34.50°）,6° -25° （mean 18.66°）,4° - 18° （mean 10.11 °） after surgery, a mean correction of 66.88%, 73.31%, 80.34%, respectively. The average postoperative sagittal curve angles were 29.50°, 27.74°, and 22.65°, a mean correction of 57.35%, 40.77%, 10.30%, respectively. 32 patients were observed for a mean of 36 months （range 12 to 78 months）. The average loss of correction was 3.01% （range 1.53% - 5.10%）. Of them, 2 were re-operated for bar breaking. Conclusion The single posterior approach with posterior release on concave side combined with skull-pelvic traction is efficient in the increase of spinal flexibility in treating severe idiopathic scoliosis. Selective pedicle screw fixation based on the classification of scoliosis obtains the same cerrection results as the whole segmental pedicle screw fixation. Thoracoplasty is blamed for decreasing of pulmonary function after surgery. However, pulmonary function would come back to preoperative status after functional training.