改良PSO截骨治疗成人特发性僵硬性脊柱侧弯

目的：评价经后路改良PSO截骨治疗成人特发性僵硬性脊柱侧弯的安全性及早期临床疗效。方法2009-05-2012-04采用经后路顶椎区改良PSO截骨、凸侧部分肋骨头颈段切除及椎弓根螺钉固定矫正治疗成人特发性僵硬性脊柱侧弯患者17例。测量患者术前术后X线片冠状面及矢状面Cobb角， C7中垂线与骶骨中垂线距离，C7铅垂线与骶骨后上缘间的水平距离（SVA间距）以及身高指标来评价侧后凸畸形的纠正和植骨融合情况。结果后凸Cobb角术前平均为50°，术后15°；侧凸Cobb角术前平均为90°，术后18°；C7中垂线与骶骨中垂线距离术前平均4.2 cm，术后0.7 cm；SVA间距术前平均4.1 cm，术后1.5 cm。术前术后比较差异均有统计学意义（P〈0.01）。结论经后路改良PSO截骨、椎弓根螺钉固定矫正治疗成人特发性僵硬性脊柱侧弯，能有效矫正畸形和恢复脊柱冠、矢状面平衡，早期结果令人满意。

Modified posterior closing wedge osteotomy in the treatment of adult idiopathic rigid scoliosis

Objective To evaluate the early clinical efficacy and safety of the modified poste-rior closing wedge osteotomy in the treatment of adult idiopathic rigid scoliosis. Methods 17 pa-tients with adult idiopathic rigid scoliosis were treated with modified posterior closing wedge os-teotomy. The pre-and post-operative kyphotic Cobb angle,the coronal plane Cobb angle,average apical translation of C7PL-CSVL,average distance of sagital plane between C7 plump line and the posterior superior corner of S1,the height as well as the bone graft fusion and the incidence of complication were accessed. Results All cases received follow-up from 12 to 28 months with an average of 20 months. The average kyphotic Cobb angle was 50°pre-operatively and 15°post-op-eratively. The average coronal plane Cobb angle was 90° pre-operatively and 18° post-operatively. The average apical translation of C7PL-CSVL was 4.2 cm pre-operatively and 0.7 cm post-opera-tively. The SVA distance was 4.1 cm pre-operatively and 1.5 cm post-operatively. There were statis-tically significant differences in the above indexes between preoperation and postoperation （P〈0.01）. All patients were present with well bone graft,no breakage and loosening of internal fixation,no obvious decompensation occurred. Conclusion The modified posterior closing wedge osteotomy combined with pedicle instrumentation for adult idiopathic rigid scoliosis can obtain satisfied cor-rection of deformity and spinal balance.