Hopf C G, Eysel P
Lubinus Klinik, Steenbeker Weg 25, 24106 Kiel, Germany.
J Pediatr Orthop B. 2000 Oct;9(4):234-43. doi: 10.1097/01202412-200010000-00005.
The principles of the operative treatment of neuromuscular scolioses differ from those of idiopathic scolioses. Depending upon the deformity in the frontal and sagittal plane, the amount of pelvic obliquity and especially the etiology of the curve, consideration of a posterior, an anterior or a combined anterior-posterior procedure is necessary. Statistics demonstrate a higher preoperative angle and a higher rate of complications combined with worse corrections in comparison with idiopathic scolioses. The existing deterioration of vital capacity in patients with Duchenne muscular dystrophy, as in patients with spinal muscle atrophy, makes an anterior approach impossible. The correction of a severe pelvic obliquity combined with a rigid lumbar or thoracolumbar scoliosis requires a combined approach in most patients suffering from myelomeningcele (MMC) and cerebral palsy. In neurofibromatosis Recklinghausen associated with an angulated kyphotic curve the anterior approach is mandatory to avoid further deterioration. Multisegmental primary-stable anterior or posterior instrumentations allow postoperative care without external support.
神经肌肉型脊柱侧凸的手术治疗原则与特发性脊柱侧凸不同。根据额状面和矢状面的畸形情况、骨盆倾斜程度，尤其是侧弯的病因，有必要考虑采用后路、前路或前后联合手术。统计数据表明，与特发性脊柱侧凸相比，神经肌肉型脊柱侧凸术前角度更大，并发症发生率更高，矫正效果更差。与脊髓性肌萎缩症患者一样，杜兴氏肌营养不良症患者现有的肺活量下降使得前路手术无法进行。对于大多数患有脊髓脊膜膨出（MMC）和脑瘫的患者，矫正严重的骨盆倾斜并伴有僵硬的腰椎或胸腰段脊柱侧凸需要采用联合手术方法。在伴有成角后凸曲线的神经纤维瘤病性雷克林霍增氏病中，必须采用前路手术以避免病情进一步恶化。多节段原发性稳定前路或后路内固定术可在术后无需外部支撑的情况下进行护理。
