合并Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸与特发性脊柱侧凸影像学特征和矫形效果比较

目的 比较合并Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸与特发性脊柱侧凸（IS）患者的影像学特征和矫形效果。 方法 回顾性分析2007年1月—2015年6月在昆明医科大学第二附属医院接受一期后路脊柱融合术治疗的合并Chiari畸形Ⅰ型和脊髓空洞症的22例脊柱侧凸患者资料（研究组），并与年龄、性别、主弯位置、侧凸数量、冠状面影像学参数1∶1配对的22例IS患者（IS组）进行比较。记录所有患者手术时间、预估出血量、融合节段数、螺钉密度等。在手术前后站立位脊柱全长正侧位X线片上测量并计算冠状面影像学参数（主弯Cobb角、侧曲角、柔韧性、顶椎位置、冠状面平衡）、矢状面后凸角、胸椎后凸角（TK）、腰椎前凸角（LL）、矢状位垂直轴（SVA）、畸形角度比（DAR）、矫形率及矫形丢失率。 结果 所有手术顺利完成，研究组随访（6.2±1.2）年，IS组随访（6.2±1.1）年。2组患者手术时间、预估出血量、融合节段数、螺钉密度差异均无统计学意义（P ＞ 0.05）。2组患者手术前后影像学参数差异均无统计学意义（P ＞ 0.05）。所有患者均未发生螺钉松动、断裂、术后神经功能损伤等并发症。 结论 术前年龄、性别、主弯位置、侧凸数量、冠状面影像学参数相匹配的情况下，伴发Chiari畸形Ⅰ型和脊髓空洞症的脊柱侧凸患者与IS患者具有相似的矢状面影像学参数和主弯柔韧性，且在一期后路脊柱融合术治疗后可获得相似的矫形效果。

Comparison of radiological features and orthopedic effects between scoliosis with Chiari Ⅰ malformation and syringomyelia and idiopathic scoliosis

Objective To compare the radiographic features and orthopedic effects between scoliosis with ChiariⅠmalformation and syringomyelia and idiopathic scoliosis（IS）. Methods The data of 22 patients with scoliosis complicated with Chiari Ⅰmalformation and syringomyelia who underwent primary posterior spinal fusion surgery（study group）at the Second Affiliated Hospital of Kunming Medical University from January 2007 to June 2015 were retrospectively analyzed，and compared with 22 IS patients（IS group） who were matched 1∶1 with age，gender，main curvature position，number of scoliosis，and coronal imaging parameters. The coronal imaging parameters（main curvature Cobb angle，bending position Cobb angle，flexibility，apical position，coronal balance），sagittal kyphosis，thoracic kyphosis（TK），lumbar lordosis（LL），sagittal vertical axis（SVA），deformity angle ratio（DAR），correction rate and correction loss rate were measured and calculated on the standing full-length anteroposterior and lateral roentgenographs of the spine before and after surgery. Results All the operations were successfully completed. The study group was followed up for （6.2±1.2） years，while the IS group for （6.2±1.1） years. There were no significant differences in operation time，estimated blood loss，number of fusion segments and screw density between the 2 groups（P ＞ 0.05）. There was no significant difference in imaging parameters between the 2 groups before and after surgery（P ＞ 0.05）. None of the patients had any complications such as screw loosening，fracture or neurological impairment after operation. Conclusion When preoperative age，gender，main curvature position，number of scoliosis and coronal imaging parameters are matched，scoliosis patients with Chiari Ⅰmalformation and syringomyelia have similar sagittal imaging parameters and main curvature flexibility to IS patients，and can achieve similar corrective effects after primary posterior spinal fusion surgery.