Min Kan, Waelchli Beat, Hahn Frederik
Deptartment of Orthopedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
Eur Spine J. 2005 Oct;14(8):777-82. doi: 10.1007/s00586-005-0977-4. Epub 2005 Aug 11.
Thoracoplasty in combination with spine fusion is an established method to address the rib cage deformity in idiopathic scoliosis. Most reports about thoracoplasty and scoliosis correction focused on Harrington or CD instrumentation. We report a retrospective analysis of 21 consecutive patients, who were treated with pedicle screw instrumentation for idiopathic thoracic scoliosis and concomitant thoracoplasty. Minimal follow up was 24 (24-75) months. Indication for thoracoplasty was clinical rib prominence of more than 15 degrees . In average there was a 44% correction of clinical rib hump, from 18 (15-25 degrees ) to 10 degrees (0-18 degrees ) (p<0.0001) and a 40% correction of radiological rib hump, from 15 (5-20 degrees ) to 9 degrees (2-15 degrees ) (p<0.0001). The preoperative pulmonary function, accessed by forced vital capacity (FVC) and one-second forced expiratory volume (FEV1), remained unchanged at the last follow up. The distal end of fusion was the end vertebra of the curve in 83.3% and the end vertebra plus one in 16.7% of the patients. There was a 68% correction of instrumented primary thoracic curves, from 60 (45-85 degrees ) to 19 degrees (5-36 degrees ) (p<0.0001), and a 45% correction of non-instrumented secondary lumbar curves, from 40 (28-60 degrees ) to 22 degrees (8-38 degrees ) (p<0.0001). Apical vertebral rotation (AVR) of the thoracic curves improved 54%, from 24 (10-35 degrees ) to 11 degrees (5-20 degrees ) (p<0.0001). The tilt of lowest instrumented vertebra (LIV) improved 68%, from 28 (20-42 degrees ) to 9 degrees (3-20 degrees ) (p<0.0001). There was no significant change in sagittal profile of the spine. Analysis with SRS-24 questionnaire showed that the majority of the patients were very satisfied with the outcome. A matched control group (n=21) operated by the same surgeon with the same operation technique but without concomitant thoracoplasty was chosen for comparison. The scoliosis correction in the two groups was comparable. The patients without thoracoplasty had 37% spontaneous improvement of the clinical rib hump.
胸廓成形术联合脊柱融合术是治疗特发性脊柱侧凸胸廓畸形的一种成熟方法。大多数关于胸廓成形术和脊柱侧凸矫正的报告都集中在哈灵顿或CD内固定术上。我们对21例连续患者进行了回顾性分析，这些患者接受了椎弓根螺钉内固定治疗特发性胸段脊柱侧凸并同期进行胸廓成形术。最短随访时间为24（24 - 75）个月。胸廓成形术的指征是临床肋骨突出超过15度。临床肋骨隆起平均矫正44%，从18（15 - 25度）降至10度（0 - 18度）（p<0.0001），放射学肋骨隆起矫正40%，从15（5 - 20度）降至9度（2 - 15度）（p<0.0001）。通过用力肺活量（FVC）和一秒用力呼气量（FEV1）评估的术前肺功能在最后随访时保持不变。83.3%的患者融合远端为弯曲的终椎，16.7%的患者为终椎加一个椎体。器械固定的原发性胸段弯曲矫正68%，从60（45 - 85度）降至19度（5 - 36度）（p<0.0001），未器械固定的继发性腰段弯曲矫正45%，从40（28 - 60度）降至22度（8 - 38度）（p<0.0001）。胸段弯曲的顶椎旋转（AVR）改善54%，从24（10 - 35度）降至11度（5 - 20度）（p<0.0001）。最低器械固定椎体（LIV）的倾斜度改善68%，从28（20 - 42度）降至9度（3 - 20度）（p<0.0001）。脊柱矢状面轮廓无显著变化。使用SRS - 24问卷分析表明，大多数患者对结果非常满意。选择由同一位外科医生采用相同手术技术但未同期进行胸廓成形术的匹配对照组（n = 21）进行比较。两组的脊柱侧凸矫正效果相当。未进行胸廓成形术的患者临床肋骨隆起自发改善37%。
