胸腰段特发性脊柱侧凸的前路矫正术

目的评价胸腰段/腰段特发性脊柱侧凸经前路矫正术的临床效果。方法1998年1月~2004年1月,76例胸腰段/腰段特发性脊柱侧凸患者接受前路选择性矫正融合术。患者共76例,男19例,女57例,平均年龄为16.2岁(13~27岁)。按照Lenke分型,Ⅴ型41例,Ⅵ型35例。其中Lenke Ⅴ型术前胸腰段侧凸Cobb角平均51.3°(38°~65°),胸段侧凸Cobb角平均35.5°(23°~41°);Lenke Ⅵ型术前胸腰段侧凸Cobb角平均53.4°(46°~68°),胸段侧凸Cobb角平均39.2°(27°~51°)。所有患者均接受侧前路矫正选择性胸腰段融合。术后以及随访中对胸腰段侧凸矫正以及胸段代偿矫正情况进行分析对比,同时采用SRS-22评分评价患者手术前后的功能状况。结果患者均安全完成手术,无严重并发症发生。所有患者均随访2年以上(2~5年)。Lenke Ⅴ型组术后胸腰段侧凸Cobb角平均11.2°(3°~15°),胸段侧凸Cobb角平均8.3°(2°~11°),最终随访时分别为13.2°(5°~17°)和10.1°(4°~15°),无躯干冠状面失代偿发生;LenkeⅥ型组术后Cobb角平均16.3°(8°~21°),胸段侧凸Cobb角平均13.7°(11°~19°),最终随访时分别为17.5°(11°~24°)和15.2°(14°~21°);仅1例发生躯干冠状面失代偿,但不需要进一步治疗。两组之间无统计学差异。所有患者均在术后以及最终随访时填写了SRS-22评分表,结果显示两组患者均对治疗结果表示满意。结论胸腰段/腰段特发性脊柱侧凸经前路矫正、选择性融合可以获得良好矫正,术后胸段弯曲能够获得较好的代偿矫正,并在远期随访中维持矫正效果和躯干冠状面的平衡。

Anterior correction for thoracolumbar idiopathic scoliosis

Objective To evaluate the radiographic outcome of anterior correction for thoracolumbar idiopathic scoliosis. Methods From January of 1998 to January of 2004, 76 cases of thoracolumbar idiopathic scoliosis, including 19 males and 57 females with an average age of 16.2 years (13-27 years),were underwent anterior correction and selective fusion. There were 41 cases of Type V curve and 35 cases of Type VI curve according to Lenke Classification. In Lenke Type V group, the average Cobb angle was 51.3° (38°-65°) for thoracolumbar curve and 35.5° (23°-41°) for thoracic curve, preoperatively. In Lenke Type VI group, the average Cobb angle was 53.4° (46°-68°) for thoracolumbar curve and 39.2° (27°-51°) for thoracic curve, preoperatively. All patients received selective thoracolumbar spine fusion anteriorly only. The clinical and radiographic outcome of these patients was analyzed and the correction of thoracolumbar curve and spontaneous correction of thoracic curve were compared pre and post operatively. SRS-24 score was used to evaluate the clinical outcome. Results All patients underwent the procedure safely without severe complications. With followed up at least two years (2-5 years). In Lenke Type V group, the average Cobb angle of thoracolumbar curve was 11.2° (3°-15°) and 8.3° (2°-11°)of thoracic curve postoperatively, which became 13.2° (5°-17°) for thoracolumbar curve and 10.1° (4°-15°) for lumbar curve at the latest follow up. No trunk imbalance was observed in this group of patients. In Lenke Type VI group, the average Cobb angle of thoracolumbar curve was 16.3° (8°-21°) and 13.7° (11°-19°) for thoracic curve postoperatively, which became 17.5° (11°-24°) for thoracolumbar curve and 15.2° (14°-21°) for lumbar curve at the latest follow up. One patient developed trunk imbalance in this group of patients and no further treatment was required. There was no statistical differences between two groups in term of correction of the main curve and the compensate curve. All patients answered questions in SRS-24 outcome instrument postoperatively and at the latest follow up. The results of SRS-24 score showed that patients all pleased with their results in both groups. Conclusion Anterior correction and selective fusion for thoracolumbar and lumbar idiopathic scoliosis can achieve satisfied clinical and radiographic outcome and spontaneous correction of the thoracic curve also achieved. At long term follow up, the correction was well maintained and no significant trunk imbalance occurred.