Zhang Hong-Zhi, Zhang Yong-Gang, Zhang Xue-Song, Mao Ke-Ya, Wang Yan
Department of Orthopedics, General Hospital of the Chinese People's Liberation Army, Beijing 100853, China.
Zhonghua Yi Xue Za Zhi. 2007 Mar 6;87(9):599-601.
To prospectively evaluate the strategy of surgery and choice of the fusion segments in thoracic adolescent idiopathic scoliosis (AIS) treatment.
Selective posterior fusion was used on 72 AIS patients, 13 male and 59 female, aged 14.3 (12 - 18), 50 being of Lenke-type IA, 8 Lenke-type IB, and 14 Lenke-type IC. In principle the upper neutral vertebrae were selected as upper instrumented vertebrae. The lower neutral vertebrae, the vertebrae 1 level proximal to the neutral vertebrae, or stable vertebrae were chosen as the lower instrumented vertebrae based on the analysis of the correlation among the lower end vertebrae, neutral vertebrae and stable vertebrae's locations. Standing anteroposterior and lateral and side-bending radiographs were taken preoperatively, postoperatively and during the follow-up. The coronal and sagittal Cobb angle, translation and rotation of apical vertebrae, and trunk translation were evaluated to observe the curve correction and trunk balance. The patients underwent spinal fusion of 7.3 segments (4 - 10 segments) on average. Follow-up was conducted for 15.9 months (12 - 39 months).
The thoracic curves' coronal Cobb angle before the operation was 56.7 degrees +/- 14.5 degrees (40 degrees - 98 degrees), and was 18.5 degrees +/- 8.3 degrees (3 degrees - 40 degrees) after the operation. The lumbar curves' coronal Cobb angle before operation was 33.9 degrees +/- 10.4 degrees (25 degrees - 69 degrees), and was 11.1 degrees +/- 6.4 degrees (0 degrees - 30 degrees ) after operation. The spontaneous correction rate was 66.9% +/- 16% (44% - 100%). The trunk translation before operation was 16.1 +/- 10.2 mm (4 - 43 mm), and was 8.2 +/- 6.1 mm (0 - 25 mm) after operation. Two patients were found with slight trunk decompensation postoperatively, but with no progression during a 2-year follow-up.
Determination of the fusion levels based on the analysis of the correlation among the end vertebrae, neutral vertebrae and stale vertebrae's location helps obtain the satisfying curative effect in the management of single thoracic curve AIS.
前瞻性评估青少年特发性脊柱侧凸（AIS）胸椎手术策略及融合节段的选择。
对72例AIS患者采用选择性后路融合术，其中男性13例，女性59例，年龄14.3岁（12 - 18岁），Lenke - IA型50例，Lenke - IB型8例，Lenke - IC型14例。原则上选择上位中立椎作为上位固定椎。根据下端椎、中立椎和稳定椎位置的相关性分析，选择下位中立椎、中立椎近端1个节段的椎体或稳定椎作为下位固定椎。术前、术后及随访期间拍摄站立位前后位、侧位及侧弯位X线片。评估冠状面和矢状面Cobb角、顶椎平移和旋转以及躯干平移，以观察侧弯矫正和躯干平衡情况。患者平均进行7.3个节段（4 - 10个节段）的脊柱融合。随访15.9个月（12 - 39个月）。
术前胸椎侧弯冠状面Cobb角为56.7°±14.5°（40° - 98°），术后为18.5°±8.3°（3° - 40°）。术前腰椎侧弯冠状面Cobb角为33.9°±10.4°（25° - 69°），术后为11.1°±6.4°（0° - 30°）。自发矫正率为66.9%±16%（44% - 100%）。术前躯干平移为16.1±10.2 mm（4 - 43 mm），术后为8.2±6.1 mm（0 - 25 mm）。2例患者术后出现轻微躯干失代偿，但在2年随访期间无进展。
通过分析端椎、中立椎和稳定椎位置的相关性来确定融合节段，有助于在单胸弯AIS的治疗中获得满意疗效。
