Lim H H, Choon D S
Department of Orthopaedics, University of Malaya, Lembah Pantai, 50603 Kuala Lumpur.
Med J Malaysia. 2000 Sep;55 Suppl C:29-34.
Segmental spinal instrumentation with Harrington rod secured to the spine by sublaminar wires was a popular method of scoliosis correction in 1980's. It was gradually replaced by newer rod-hook systems due to concern about neurological complications. However, correction of type II and III curves by selectively fusing the thoracic curves with these new instruments has resulted in poor results in some cases. The aim of this study is to review the result of selective thoracic fusion treated by segmental spinal instrumentation. Between January 1989 to October 1994, 31 patients with King II scoliosis were treated operatively in our unit. These consisted of 29 girls and 2 boys. The mean age of these patients were 11.3 years. The study population consisted of 21 Chinese, 5 Malays and 5 Indians. In one patient, the thoracic curve was convex to the left whilst the thoracic curves in the majority were to the right. The surgery was performed by three surgeons using harrington rods and posterior fusion with autograft. Anterior releases were also required in eight patients to increase flexibility. The curve correction obtained was an improvement from a average preoperative cobb's angle of 71.5 degrees to 39.5 degrees postoperatively. After an average follow-up period of 77.9 months, the correction deteriorated by 22% in the thoracic curve and 59% in the lumbar spine without disturbance to truncal balance. Only one sublaminar wire broke. However, no implant failure or removal has to be performed as yet. This technique appears useful in our institution with minimal morbidity.
20世纪80年代，通过椎板下钢丝将哈灵顿棒固定于脊柱的节段性脊柱内固定术是一种常用的脊柱侧弯矫正方法。由于担心神经并发症，它逐渐被更新的棒钩系统所取代。然而，使用这些新器械选择性融合胸段曲线来矫正II型和III型曲线，在某些情况下效果不佳。本研究的目的是回顾节段性脊柱内固定术治疗选择性胸段融合的结果。1989年1月至1994年10月，我们科室对31例King II型脊柱侧弯患者进行了手术治疗。其中包括29名女孩和2名男孩。这些患者的平均年龄为11.3岁。研究人群包括21名中国人、5名马来人和5名印度人。1例患者胸段曲线向左凸，而大多数患者的胸段曲线向右凸。手术由三位外科医生采用哈灵顿棒并进行自体骨后路融合完成。8例患者还需要进行前路松解以增加柔韧性。获得的曲线矫正效果是，术前平均 Cobb角为71.5度，术后改善至39.5度。平均随访77.9个月后，胸段曲线矫正度恶化了22%，腰椎恶化了59%，但躯干平衡未受影响。仅1根椎板下钢丝断裂。然而，目前尚未进行植入物取出或翻修手术。在我们机构，这项技术似乎有用，且发病率极低。
