钴铬棒在青少年特发性脊柱侧凸矫形手术中的应用

目的探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形手术中使用不同内固定棒的效果。方法收集2011年1月~2013年8月本院收治的AIS患者临床资料(n=134)。根据手术中使用的内固定棒类型将患者分为钴铬棒(cobalt chromium,Co Cr)组(n=33)和同直径的钛棒(titanium,Ti)组(n=101)。术前、术后及末次随访时拍摄脊柱X线片并测量冠状面主弯Cobb角、胸椎后凸角、胸腰段前凸角、腰椎前凸角,进行对比研究。结果 Co Cr组患者主弯角度术后为14.72°±5.01°,末次随访为16.12°±5.48°,末次随访主弯角度丢失1.40°±3.07°;胸椎后凸角术后为22.19°±5.44°,末次随访为21.27°±5.34°。Ti组患者主弯角度术后为17.37°±12.10°,末次随访为20.25°±9.56°,末次随访主弯角度丢失2.89°±4.27°;胸椎后凸角术后为18.02°±7.98°,末次随访为16.53°±6.93°。2组术后主弯角度、末次随访主弯角度、末次随访主弯角度丢失、术后胸椎后凸角、末次随访胸椎后凸角,差异均有统计学意义(P0.05)。结论在AIS矫形中,与钛棒相比,钴铬棒可在冠状面上提供更大的矫形力,更重要的是可以防止由于矫形引起的矢状面胸椎后凸角减少,维持较好的矢状面生理曲度。

Research on application of CoCr rods in orthopedic surgery of adolescent idiopathic scoliosis

Objective A retrospective study based on the results of using different fixation rods in orthopedic surgery of adolescent idiopathic scoliosis (AIS). Methods From January 2011 to August 2013,134 AIS patients who underwent posterior orthomorphia operation were reviewed. Cobalt chromium (CoCr) group (33 patients) were treated with CoCr rods. Titanium (Ti) group (101 patients) were treated with Ti rods. The major curve Cobb's angle, thoracic kyphosis, thoracolumbar lordosis, lumbar lordosis were measured preoperotive and postoperative and at final follw-up. Comparative study was performed on the above indicators. Results Postoperative major curve Cobb's angle of CoCr group was 14.72°±5.01°, at final follow-up was 16.12°±5.48°, major curve loss of correction at final follow-up was 1.40°±3.07°. Postoperative thoracic kyphosis was 22.19°±5.44°, at final follow-up was 21.27°±5.34°. Postoperative major curve Cobb's angle of Ti group was 17.37°±12.10°, at final follow-up was 20.25°±9.56°, major curve loss of correction final follow-up was 2.89°±4.27°. Postoperative thoracic kyphosis was 18.02°±7.98°, at final follow-up was 16.53°±6.93°. Significant difference (P< 0.05) were observed in postoperative and final follow-up major curve Cobb's angle, major curve loss of correction at final follow-up, postoperative and final follow-up thoracic kyphosis of the 2 groups. Conclusion In orthopedic surgery of AIS, CoCr rods compares with Ti rods, can provide greater correction forces on the coronal plane. More importantly, it can prevent the induce of sagittal thoracic kyphosis due to the orthopaedic, and maintain a good sagittal curve.