杜氏肌营养不良症中使用椎弓根螺钉进行脊柱侧弯矫正。

Scoliosis correction with pedicle screws in Duchenne muscular dystrophy.

作者信息

Hahn Frederik, Hauser Dominik, Espinosa Norman, Blumenthal Stefan, Min Kan

机构信息

Department of Orthopaedics, Balgrist Clinic, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.

出版信息

Eur Spine J. 2008 Feb;17(2):255-61. doi: 10.1007/s00586-007-0558-9. Epub 2007 Dec 4.

Abstract

This report describes the spinal fixation with pedicle-screw-alone constructs for the posterior correction of scoliosis in patients suffering from Duchenne muscular dystrophy (DMD). Twenty consecutive patients were prospectively followed up for an average of 5.2 years (min 2 years). All patients were instrumented from T3/T4 to the pelvis. Pelvic fixation was done with iliac screws similar to Galveston technique. The combination of L5 pedicle screws and iliac screws provided a stable caudal foundation. An average of 16 pedicle screws was used per patient. The mean total blood loss was 3.7 l, stay at the intensive care unit was 77 h and hospital stay was 19 days. Rigid stabilisation allowed immediate mobilisation of the patient in the wheel chair. Cobb angle improved 77% from 44 degrees to 10 degrees, pelvic tilt improved 65% from 14 degrees to 3 degrees. Lumbar lordosis improved significantly from 20 degrees to 49 degrees, thoracic kyphosis remained unchanged. No problems related to iliac fixation, no pseudarthrosis or implant failures were observed. The average percentage of predicted forced vital capacity (%FVC) of the patients was 55% (22-94%) preoperatively and decreased to 44% at the last follow-up. There were no pulmonary complications. One patient with a known cardiomyopathy died intraoperatively due to a sudden cardiac arrest. The rigid primary stability with pedicle screws allowed early mobilisation of the patients, which helped to avoid pulmonary complications.

摘要

本报告描述了仅使用椎弓根螺钉进行脊柱固定,用于杜氏肌营养不良症(DMD)患者脊柱侧弯的后路矫正。对连续20例患者进行了前瞻性随访,平均随访5.2年(最短2年)。所有患者均从T3/T4至骨盆进行器械固定。采用与加尔维斯顿技术类似的髂骨螺钉进行骨盆固定。L5椎弓根螺钉和髂骨螺钉的组合提供了稳定的尾端基础。每位患者平均使用16枚椎弓根螺钉。平均总失血量为3.7升,在重症监护病房的停留时间为77小时,住院时间为19天。坚强固定使患者能够立即在轮椅上活动。Cobb角从44度改善至10度,改善了77%;骨盆倾斜从14度改善至3度,改善了65%。腰椎前凸从20度显著改善至49度,胸椎后凸保持不变。未观察到与髂骨固定相关的问题、假关节或植入物失败。患者术前预计用力肺活量(%FVC)的平均百分比为55%(22 - 94%),在最后一次随访时降至44%。未出现肺部并发症。1例已知患有心肌病的患者术中因心脏骤停死亡。椎弓根螺钉的坚强初始稳定性使患者能够早期活动,有助于避免肺部并发症。

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