Parsch D, Geiger F, Brocai D R, Lang R D, Carstens C
Stiftung Orthopädische Universitätsklinik Heidelberg, Schlierbacher Landstrasse 200 A, D-69118 Heidelberg, Germany.
J Pediatr Orthop B. 2001 Jan;10(1):10-7.
A retrospective analysis of 54 patients with paralytic scoliosis due to myelomeningocele, who underwent surgical treatment, was performed. The aim of this study was to compare different surgical techniques and to identify clinical parameters influencing primary and midterm results. Three surgical techniques were used: 1) group I, posterior fusion/instrumentation; 2) group II, anterior fusion/no instrumentation combined with posterior fusion/instrumentation; and 3) group III, anterior and posterior fusion/instrumentation. Average age at surgery was 13.1 years. A preoperative scoliosis angle of 90 degrees [interquartile range (25th-75th percentile) (IQR), 76-106 degrees] was primarily reduced to 38 degrees (IQR, 30-50 degrees). At final follow-up (mean, 3.3 years), correction deteriorated to 44 degrees (IQR, 38-65 degrees). The group III procedure resulted in a better midterm correction of scoliosis compared with group I (P = 0.02). The extension of anterior fusion correlated with primary and midterm correction of scoliosis (P < 0.03). Patients with a thoracic level of paralysis had a higher relative loss of correction compared with patients with a lumbar level (P < 0.06). This finding can be attributed mostly to group I patients (P = 0.011). Hardware complications occurred in 16 patients (30%). Relative loss of correction among these patients was high (P < 0.01) and relative midterm correction low (P = 0.001). We recommend anterior and posterior fusion, each with instrumentation for the treatment of paralytic scoliosis in myelomeningocele. In patients with a thoracic level of paralysis, the two-stage procedure is mandatory to reduce the risk of hardware complications and subsequent major loss of correction.
对54例因脊髓脊膜膨出导致麻痹性脊柱侧弯并接受手术治疗的患者进行了回顾性分析。本研究的目的是比较不同的手术技术，并确定影响初次和中期手术效果的临床参数。采用了三种手术技术：1）第一组，后路融合/器械固定；2）第二组，前路融合/无器械固定联合后路融合/器械固定；3）第三组，前路和后路融合/器械固定。手术时的平均年龄为13.1岁。术前脊柱侧弯角度90度[四分位间距（第25-75百分位数）（IQR），76-106度]主要减小至38度（IQR，30-50度）。在最终随访时（平均3.3年），矫正度数恶化至44度（IQR，38-65度）。与第一组相比，第三组手术在脊柱侧弯的中期矫正方面效果更好（P = 0.02）。前路融合的范围与脊柱侧弯的初次和中期矫正相关（P < 0.03）。与腰椎水平麻痹的患者相比，胸椎水平麻痹的患者矫正丢失相对更高（P < 0.06）。这一发现主要归因于第一组患者（P = 0.011）。16例患者（30%）出现了内固定并发症。这些患者的矫正相对丢失较高（P < 0.01），中期相对矫正较低（P = 0.001）。我们建议采用前路和后路融合并分别进行器械固定来治疗脊髓脊膜膨出所致的麻痹性脊柱侧弯。对于胸椎水平麻痹的患者，两阶段手术是必要的，以降低内固定并发症及随后矫正大量丢失的风险。
