Yang Shu-Hua, Chen Po-Quang
Department of Orthopedics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
Clin Orthop Relat Res. 2003 Jun(411):152-8. doi: 10.1097/01.blo.0000069885.72909.bb.
Thoracolumbar idiopathic scoliosis usually is treated by anterior spinal fusion. However, short posterior spinal fusion that includes only the structural curve has been tried in a limited number of patients. The fusion may end cranially in the lower thoracic region and cause an increase in sagittal decompensation at the proximal junction. From July 1989 to July 1998, 14 patients were treated with thoracolumbar idiopathic scoliosis by short posterior spinal fusion. The lateral radiographs were evaluated preoperatively, immediately postoperative, and during followup. The focal kyphotic angle was used to examine the changes in focal sagittal alignment. A 10 degrees progression was defined as the radiographic criterion for the development of junctional kyphosis. Proximal junctional kyphosis occurred in six of the 14 patients, in which one patient needed revision surgery. In all six patients, the average preoperative lumbar lordosis was greater than 35 degrees, and decreased more than 10 degrees during surgery. In the five patients with a focal kyphotic angle larger than 10 degrees, four had proximal junctional kyphosis develop. According to the current findings, short posterior spinal fusion can be done only if the focal kyphotic angle proximal to the fusion is less than 10 degrees, and the lumbar lordosis must be preserved carefully during surgery.
胸腰段特发性脊柱侧弯通常采用前路脊柱融合术治疗。然而，仅包括结构性弯曲的短节段后路脊柱融合术已在少数患者中尝试过。融合可能在胸段下部的头侧结束，并导致近端交界处矢状面失代偿增加。从1989年7月至1998年7月，14例胸腰段特发性脊柱侧弯患者接受了短节段后路脊柱融合术治疗。术前、术后即刻及随访期间均对侧位X线片进行评估。采用局部后凸角来检查局部矢状面排列的变化。将10度的进展定义为交界性后凸发展的影像学标准。14例患者中有6例发生近端交界性后凸，其中1例患者需要翻修手术。在所有6例患者中，术前平均腰椎前凸大于35度，手术期间减少超过10度。在局部后凸角大于10度的5例患者中，4例发生了近端交界性后凸。根据目前的研究结果，仅当融合近端的局部后凸角小于10度时，才可进行短节段后路脊柱融合术，并且手术期间必须小心保留腰椎前凸。
