Schulte Tobias L, Liljenqvist Ulf, Hierholzer Eberhard, Bullmann Viola, Halm Henry F, Lauber Sebastian, Hackenberg Lars
Department of Orthopaedics, University Hospital Münster, Germany.
Spine (Phila Pa 1976). 2006 Feb 1;31(3):315-21. doi: 10.1097/01.brs.0000197409.03396.24.
Clinical, rasterstereographic, and radiographic evaluation of spontaneous vertebral derotation of secondary curves in idiopathic scoliosis following selective anterior correction and fusion of the primary curve.
To quantify spontaneous vertebral derotation in secondary curves after selective anterior correction with attention to cosmetic outcome.
While the derotational effect of anterior instrumentation techniques on the instrumented curve is well understood, there is a paucity on data of the rotational behavior of the noninstrumented secondary curves.
A total of 43 patients with idiopathic scoliosis (16 with thoracic curves in group 1 and 27 with thoracolumbar/lumbar curves in group 2) underwent selective anterior instrumentation. Vertebral rotation was analyzed before surgery and, on average, 20 months after surgery using digital radiometric rotation analysis, back shape analysis with rasterstereography, and scoliometer measurement.
In Group 1, there was a significant spontaneous vertebral derotation of the secondary lumbar curves by 14.2% (range from 12.7 degrees to 10.9 degrees) in the digital radiometric rotation analysis, surface derotation amounted to 49% (range from 9.6 degrees to 4.9 degrees) in the rasterstereography, and to 70% in the clinical scoliometer measurement (range from 8.0 degrees to 2.4 degrees ). In group 2, there was an increase of rotation of the noninstrumented secondary thoracic curves by 30% (range from 5.0 degrees to 6.5 degrees ) in digital radiometry, by 32.9% in the rasterstereography (range from 8.5 degrees to 11.3 degrees), and a 28.3% increase in scoliometer measurement (range from 6.0 degrees to 7.7 degrees).
Selective anterior instrumentation and fusion of primary thoracic curves results in satisfactory spontaneous vertebral and high surface derotation of the secondary lumbar curves. However, in primary thoracolumbar or lumbar curves, an increase of both vertebral and surface rotation of the secondary thoracic curve was noted. This increase can impair cosmetic outcome.
对特发性脊柱侧凸主弯选择性前路矫正融合术后继发曲度的自发椎体旋转进行临床、光栅立体摄影及影像学评估。
在关注美容效果的情况下，量化选择性前路矫正术后继发曲度的自发椎体旋转。
虽然前路内固定技术对固定曲度的旋转效果已为人熟知，但关于未固定继发曲度旋转行为的数据却很匮乏。
43例特发性脊柱侧凸患者（1组16例为胸段曲度，2组27例为胸腰段/腰段曲度）接受了选择性前路内固定。术前及术后平均20个月采用数字放射测量旋转分析、光栅立体摄影背部形态分析及脊柱侧凸测量仪测量来分析椎体旋转情况。
在1组中，数字放射测量旋转分析显示继发腰段曲度有显著的自发椎体旋转，达14.2%（范围为12.7度至10.9度），光栅立体摄影显示表面旋转达49%（范围为9.6度至4.9度），临床脊柱侧凸测量仪测量显示为70%（范围为8.0度至2.4度）。在2组中，数字放射测量显示未固定的继发胸段曲度旋转增加30%（范围为5.0度至6.5度），光栅立体摄影显示增加32.9%（范围为8.5度至11.3度），脊柱侧凸测量仪测量显示增加28.3%（范围为6.0度至7.7度）。
选择性前路内固定及主胸段曲度融合可使继发腰段曲度获得满意的自发椎体旋转及较高的表面旋转。然而，在主胸腰段或腰段曲度中，继发胸段曲度的椎体及表面旋转均有增加。这种增加可能会影响美容效果。
