Gaine W J, Lim J, Stephenson W, Galasko C S B
The Royal Manchester Children's Hospital, Manchester, UK.
J Bone Joint Surg Br. 2004 May;86(4):550-5.
A consecutive series of 85 patients with Duchenne's muscular dystrophy who underwent spinal fusion over a period of 16 years was followed up with regard to the progression of the scoliosis and pelvic obliquity. Of 74 patients with adequate radiographic follow-up, 55 were instrumented with the Luque single-unit rod system and 19 with the Isola pedicle screw system; seven were instrumented to L3/4, 42 to L5, 15 to S1 and 10 to the pelvis with intrailiac rods. The mean period of follow-up was 49 months (SD 22) before and 47 months (SD 24) after operation. There was one peri-operative death and three cases of failure of hardware. The mean improvement in the Cobb angle was 26 degrees and in pelvic obliquity, 9.2 degrees. Fusion to L3/4 achieved a poorer correction of both curves while intrapelvic rods, achieved and maintained the best correction of pelvic obliquity. Fusion to S1 did not provide any benefit over more proximal fusion excluding the sacrum, with regard to correction and maintenance of both angles. The Isola system appeared to provide and maintain a slightly better correction of the Cobb angle.
对连续85例在16年期间接受脊柱融合术的杜氏肌营养不良症患者进行了脊柱侧凸和骨盆倾斜进展情况的随访。在74例有足够影像学随访资料的患者中,55例采用Luque单节段棒系统进行器械固定,19例采用Isola椎弓根螺钉系统;7例固定至L3/4,42例固定至L5,15例固定至S1,10例采用髂内棒固定至骨盆。术前平均随访时间为49个月(标准差22),术后为47个月(标准差24)。有1例围手术期死亡和3例内固定失败。Cobb角平均改善26度,骨盆倾斜平均改善9.2度。融合至L3/4对两个弯曲的矫正效果较差,而髂内棒对骨盆倾斜的矫正效果最佳且能维持。就两个角度的矫正和维持而言,融合至S1与不包括骶骨的更靠近近端的融合相比没有任何优势。Isola系统似乎能提供并维持对Cobb角稍好的矫正效果。
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