Zhang Jian-guo, Qiu Gui-xing, Wang Yi-peng, Weng Xi-sheng, Yu Bin, Xu Hong-guang, Yang Xin-yu, Ren Yu-zhu
Department of Orthopaedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2004 Feb 22;42(4):216-9.
To define the criteria of selective thoracic fusion in adolescent idiopathic scoliosis patients.
By reviewing the roentgenograms of adolescent idiopathic scoliosis patients undergoing selective thoracic fusion, the curve type, Cobb angle, apical rotation and translation, trunk shift, and thoracolumbar kyphosis were measured and analyzed.
There were 12 King type II patients (PUMC type: IIb1 9, IIc3 3). The coronal Cobb angle of thoracic curve before and after surgery were 54.0 degrees and 19.0 degrees respectively, and the average correction rate was 62.7%. The coronal Cobb angle of lumbar curve before and after surgery were 34.6 degrees and 12.5 degrees respectively, and the average spontaneous correction rate was 64.7%. At the final follow-up, the coronal Cobb angle of thoracic and lumbar curve was 18.8 degrees and 15.9 degrees respectively. There was no significant change in the coronal Cobb angle, apical vertebral translation and rotation compared with that after surgery. 1 patient had 12 degrees of thoracolumbar kyphosis after surgery, no progression was noted at the final follow-up. There was no trunk decompensation or deterioration of the lumbar curve. In this group, 3.5 levels were saved compared with fusing both the thoracic and lumbar curves.
Selective thoracic fusion can be safely and effectively performed in patients with a moderate and flexible lumbar curves, which can save more mobile segments to maintain a good coronal and sagittal balance.
确定青少年特发性脊柱侧凸患者选择性胸段融合的标准。
通过回顾接受选择性胸段融合的青少年特发性脊柱侧凸患者的X线片，测量并分析其曲线类型、Cobb角、顶椎旋转和移位、躯干偏移以及胸腰段后凸。
有12例King II型患者（协和医院分型：IIb1型9例，IIc3型3例）。胸段曲线术前和术后的冠状面Cobb角分别为54.0度和19.0度，平均矫正率为62.7%。腰段曲线术前和术后的冠状面Cobb角分别为34.6度和12.5度，平均自发矫正率为64.7%。在末次随访时，胸段和腰段曲线的冠状面Cobb角分别为18.8度和15.9度。与术后相比，冠状面Cobb角、顶椎移位和旋转无明显变化。1例患者术后出现12度的胸腰段后凸，末次随访时未见进展。无躯干失代偿或腰段曲线恶化。与融合胸段和腰段曲线相比，该组节省了3.5个活动节段。
对于腰段曲线中度且柔韧的患者，可安全有效地进行选择性胸段融合，这可以保留更多活动节段以维持良好的冠状面和矢状面平衡。
