Benlï I Teoman, Büyukgullu Osman, Altuģ Tibet, Akalin Serdar, Kurtuluş Burhan, Aydin Erbil
Assoc.Prof. Dr, Surgeon of Orthopaedics and Travmatology, Ankara Social Security Hospital, 1st Department of Orthopaedics and Traumatology, Ankara, Turkey.
Kobe J Med Sci. 2004;50(3-4):83-100.
In recent years, third generation instrumentation systems which achieve correction by maneuvers like derotation and translation, have been widely used in the treatment of idiopathic scoliosis. To increase correction, additional procedures that increase stability, such as screw application for every segment, have been used. In this study, as a new technique, the effects of combined translation and derotation maneuver with augmentation by using titanium double crimp Songer cable applied on apical region, on trunk balance, sagittal and frontal planes have been examined. 45 idiopathic scoliosis patients operated between 1996 and 2002 have been included in the study. Mean age was 14.5+/-1.7 years and female/male ratio was 30/15. Mean follow up time was 51.9+/-22.7 months. According to King Classification, 15 patients had Type II, 18 patients Type III and 12 patients had Type IV curves. One of the apical cables has been tensioned and translation has been performed. At the second step, derotation has been applied to the vertebra, which is firmly attached to the rod. Sagittal and frontal Cobb angles have been measured in preoperative, postoperative and recent radiographic examinations. Trunk balance has been examined both clinically and radiographically. Also, secondary curves have been measured in every examination for decompensation findings. In overall frontal plane measurements, postoperative correction was 79.9+/-13.5 %, loss of correction 2.9 degrees +/-3.2 degrees and final correction 74.3 % +/-14.3 %. In postoperative measurements, normal physiological contours have been achieved in 97.8 % of the patients for the thoracic region (30 degrees -50 degrees ) and 80.7 % of the patients for the lumbar region (40 degrees -60 degrees ). In secondary curves, 75.2+/-34.4 % postoperative correction has been observed. No decompensation findings have been observed in the last examination. In postoperative and last follow up examinations, balanced and totally balanced vertebral column has been achieved in every patient of the study group. Solid fusion mass has been observed in every patient. No early or late, local or systemic postoperative complications have been observed. Given these findings, we conclude that derotation-translation combined maneuver performed with 3rd generation instrumentation reinforced sublaminar wires is a good choice in the treatment of the late-onset idiopathic scoliosis.
近年来，通过去旋转和平移等操作实现矫正的第三代器械系统已广泛应用于特发性脊柱侧凸的治疗。为了增加矫正效果，人们采用了一些增强稳定性的附加手术，比如对每个节段应用螺钉。在本研究中，作为一项新技术，我们检验了在顶椎区域应用钛质双折边宋格钢丝进行平移和去旋转联合操作并增强固定后，对躯干平衡以及矢状面和额状面的影响。本研究纳入了1996年至2002年间接受手术的45例特发性脊柱侧凸患者。平均年龄为14.5±1.7岁，女性/男性比例为30/15。平均随访时间为51.9±22.7个月。根据金氏分类法，15例患者为II型，18例患者为III型，12例患者为IV型曲线。其中一根顶椎钢丝被拉紧并进行平移操作。第二步，对牢固连接在棒上的椎体进行去旋转操作。在术前、术后及近期的影像学检查中测量矢状面和额状面的 Cobb 角。从临床和影像学两方面检查躯干平衡情况。此外，在每次检查中测量二次曲线以发现失代偿情况。在整体额状面测量中，术后矫正率为79.9±13.5%，矫正丢失2.9度±3.2度，最终矫正率为74.3%±14.3%。在术后测量中，97.8%的患者胸椎区域（30度 - 50度）实现了正常生理曲度，80.7%的患者腰椎区域（40度 - 60度）实现了正常生理曲度。在二次曲线中，观察到术后矫正率为75.2±34.4%。在最后一次检查中未发现失代偿情况。在术后及最后一次随访检查中，研究组的每位患者均实现了脊柱平衡及完全平衡。在每位患者中均观察到了坚实的融合块。未观察到早期或晚期、局部或全身的术后并发症。基于这些发现，我们得出结论，采用第三代器械并辅以椎板下钢丝进行去旋转 - 平移联合操作是治疗晚发性特发性脊柱侧凸的一个不错选择。
