大重量牵引辅助一期后路手术治疗100°以上青少年特发性脊柱侧凸

目的 探讨大重量牵引辅助、一期后路手术治疗100°以上青少年特发性脊柱侧凸(adole-cent idiopathetic scoliosis,AIS)的可行性及临床疗效.方法 2003年12月至2006年8月,我科共收治29例Risser征3～5级、主弯100°以上的AIS患者.按手术方法不同分为两组:A组12例,先行前路松解,后行头环+双侧股骨髁上牵引,2周后二期行后路钉(钩)棒系统矫形内固定植骨融合术;B组17例,先行头环+双侧股骨髁上牵引,2周后在牵引下行一期后路广泛松解、钉(钩)棒系统矫形内固定植骨融合术.29例患者均获随访,平均18个月(12～38个月);对比两组患者的一般资料、手术情况及影像学资料.结果 29例患者无一例死亡,3例发牛背部压疮、l例发牛前路松解术后暂时性肺功能严重下降.术后12个月内所有病例固定节段均获骨性融合,无假关节形成及断棒(钉)发生,至未次随访所有病例矫形较术后均无明显丢失.两组患者在性别构成、于术时年龄、侧凸类型、术前主弯Cobb角、柔软件、末次随访矫形率等方面差异均无统计学意义(P>O.05);但B组患者在平均手术时间、失血量及住院天数方面均显著小于A组(P<0.01).结论 对Risser征3级以上、主弯大于100°的AIS患者,通过火重量牵引辅助及后路的广泛松解、单纯后路手术即可达到与前后路联合手术相当的矫形效果;同时单纯后路手术可明显地缩短手术时间、减少出血量和住院天数.

Posterior surgery assisted with high-weight halo-femoral traction for the treatment of adolescent idiopathic scoliotic with the curves more than 100°

Objective To investigate the feasibility and clinical efficacy of the treatment of adolescent idiopathic scoliotic(AIS)with the curves more than 100°by posterior surgery assisted with high-weight halo-femoral traction and posterior wide release.Methods From December 2003 to August 2006,29 AIS patients with the curves more than 100.and Risser'S sign 3-5 were involved in this study.According to treatment method,two groups were divided:12 patients in Group A underwent combined anterior release followed by 2-week halo-femoral traction and then,posterior instrumentation;17 patients in Group B underwent posterior sugery alone assisted by high-weight halo-femoral traction and posterior wide release.All patients were analyzed in general date,operation and radiographic material.Results 29 patients were followed up for 12-38 months.3 patients with bedsores and 1 patient with temporary severe pulmonary function impairment.All patients got bony fusion of the fixation segments within 12 months.There were no significant differences between the two groups in gender,age,type of AIS,preoperative coronal major curve values,major curve flexibility,or final-visit major carve correction rate.The average operative time,blood loss and hospital stay in group B,were significantly less than those in group A(P<0.01).Conclusion:For the AIS with cobb>100.and Risser'S sign 3-5,posterior surgery assisted with high-weight halo-femoral traction and posterior wide release,can provide comparative correction rate to anterior-posterior surgery,with more less operative time,less blood loss and less hospital stay.