Hosoe Hideo, Miyamoto Kei, Wada Eiji, Shimizu Katsuji
Department of Orthopaedic Surgery, Gifu University School of Medicine, Yanagido, Gifu City, Japan.
Spine (Phila Pa 1976). 2006 May 1;31(10):E302-6. doi: 10.1097/01.brs.0000216447.42297.17.
This is a report of a 12-year-old girl treated surgically for scoliosis associated with bilateral hip dislocation in Larsen syndrome.
To describe a rare case of scoliosis associated with Larsen syndrome and bilateral hip dislocation that was treated surgically with follow-up for 15 years.
There are few reports of the long-term follow-up of cases involving surgically treated scoliosis associated with bilaterally dislocated hips.
The patient's spine showed a right thoracic curve (T5-T12) with a Cobb angle of 77 degrees and did not show pelvic obliquity on an anterior-posterior radiograph film. On the sagittal alignment of her spine, the thoracic spine showed an abnormal lordosis (T5-T12: 19 degrees), and the lumbar spine had a hyperlordosis (L1-S1: 57 degrees) with a large lumbosacral angle (72 degrees ). We performed a posterior spinal fusion between T4 and L2 using Cotrel-Dubousset Instrumentation, anticipating the restoration of normal lumbar and cervical lordosis, as well as thoracic kyphosis.
The Cobb angle of thoracic scoliosis improved from 77 degrees to 28 degrees, and a thoracic kyphosis of 12 degrees (T5-T12) was obtained. Subsequently, on the sagittal plane, the lumbosacral angle (sacral anteflexion) decreased from 72 degrees to 52 degrees, comparable to that of patients with hip dislocation, and the lumbar lordotic angle increased from 57 degrees to 66 degrees. The restoration of thoracic kyphosis resulted in an increase of lumbar lordosis and decrease of sacral anteflexion. At the 15-year follow-up,although the thoracic scoliosis (T5-T12) had increased to 36 degrees, good coronal and sagittal balance had been maintained. The patient is asymptomatic in her spine and hip.
A case of scoliosis associated with dislocated hips in a patient with Larsen syndrome was successfully treated with posterior correction surgery. Fusion surgery between T4 and L2 provided an ideal sagittal balance of the total spine, while preserving 4 lumbar mobile segments.
本文报告了一名12岁女孩，因拉森综合征合并双侧髋关节脱位导致脊柱侧弯，接受了手术治疗。
描述一例罕见的拉森综合征合并双侧髋关节脱位导致脊柱侧弯并接受手术治疗且随访15年的病例。
关于双侧髋关节脱位合并脊柱侧弯手术治疗病例的长期随访报道较少。
患者脊柱在前后位X线片上显示右侧胸弯（T5 - T12），Cobb角为77度，未见骨盆倾斜。在脊柱矢状位排列上，胸椎显示异常前凸（T5 - T12：19度），腰椎有过度前凸（L1 - S1：57度），腰骶角较大（72度）。我们使用Cotrel - Dubousset器械在T4和L2之间进行了后路脊柱融合术，预期恢复正常的腰椎和颈椎前凸以及胸椎后凸。
胸段脊柱侧弯的Cobb角从77度改善至28度，获得了12度的胸椎后凸（T5 - T12）。随后，在矢状面上，腰骶角（骶骨前屈）从72度降至52度，与髋关节脱位患者相当，腰椎前凸角从57度增加至66度。胸椎后凸的恢复导致腰椎前凸增加和骶骨前屈减少。在15年随访时，尽管胸段脊柱侧弯（T5 - T12）增加至36度，但冠状面和矢状面仍保持良好平衡。患者脊柱和髋关节无症状。
拉森综合征患者合并髋关节脱位导致的脊柱侧弯病例通过后路矫正手术成功治疗。T4和L2之间的融合手术实现了整个脊柱理想的矢状面平衡，同时保留了4个腰椎活动节段。
