Wood K B, Transfeldt E E, Ogilvie J W, Schendel M J, Bradford D S
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis.
Spine (Phila Pa 1976). 1991 Aug;16(8 Suppl):S404-8.
Ten consecutive patients with adolescent idiopathic scoliosis and King-Moe curve Types II and III, scheduled consecutively for Cotrel-Dubousset instrumentation, underwent pre- and postoperative computed tomography scans with axial slices through each vertebra, and including the pelvis. Vertebral rotation was measured and referenced to the pelvis. Average derotation of the thoracic apex after surgery was 9%. King-Moe Type II curves tended to derotate more successfully (average 26% improvement), while Type III curves derotated very little, if at all (average 1.3% worsening of the rotational deformity). Type II curves often showed segmental rotational changes outside the levels of instrumentation, while Type III curves did not; more frequently the spinal-pelvic axis rotated en bloc. It appears, therefore, that Cotrel-Dubousset instrumentation does not consistently or predictably derotate the thoracic apex relative to the pelvis, and coronal plane correction may only be apparent, due to transmitted torque and rotation of the entire spinal-pelvic axis.
连续十位患有青少年特发性脊柱侧凸且King - Moe曲线为II型和III型的患者，连续安排接受Cotrel - Dubousset器械固定手术，术前行计算机断层扫描，轴向切片穿过每个椎体并包括骨盆，术后再次进行扫描。测量椎体旋转并以骨盆为参照。术后胸段顶点的平均去旋转角度为9%。King - Moe II型曲线往往去旋转更成功（平均改善26%），而III型曲线去旋转极少（如果有改善的话）（旋转畸形平均恶化1.3%）。II型曲线常在器械固定节段以外出现节段性旋转变化，而III型曲线则没有；更常见的是脊柱 - 骨盆轴整体旋转。因此，相对于骨盆而言，Cotrel - Dubousset器械固定似乎并不能始终如一地或可预测地使胸段顶点去旋转，并且由于整个脊柱 - 骨盆轴的传递扭矩和旋转，冠状面矫正可能只是表面现象。
