Lu Wen-can, Zhang Jian-guo, Qiu Gui-xing, Sadik Ilgar, Wang Yi-peng, Yu Bin, Zhao Hong, Zhao Yu, Weng Xi-sheng
Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Wai Ke Za Zhi. 2009 May 15;47(10):758-61.
To evaluate the outcomes of selective anterior thoracolumbar or lumbar (TL/L) fusion for adolescent idiopathic scoliosis (AIS) with PUMCIId1 curves (Lenke type 5).
Thirty-five consecutive AIS patients (PUMC type IId1, Lenke type 5) with selective anterior TL/L fusion with single solid rod instrumentation were reviewed. The average follow-up was 36 months (range, 18 - 42 months). Standing anteroposterior and lateral radiographs were measured and analyzed.
The average preoperative Cobb angle of the TL/L curves was 45.6 degrees and corrected to 9.7 degrees postoperatively, with 79.7% curve correction. The thoracic curves decreased from 29.7 degrees preoperatively to 17.6 degrees postoperatively, with a spontaneous correction of 41.5%. There was an average 4.7 degrees and 2.5 degrees correction loss of the TL/L and the thoracic curves at the final follow-up respectively. Trunk shift deteriorated slightly from 14.0 mm preoperatively to 14.8 mm postoperatively, and improved significantly to 5.1 mm at the final follow-up. The lowest instrumented vertebra (LIV) tilt was significantly improved after surgery (from -21.8 degrees preoperatively to -1.5 degrees postoperatively) and well maintained at the final follow-up (-2.1 degrees). The coronal disc angle immediately above the upper instrumented vertebra (UIVDA) and below the LIV (LIVDA) averaged 0.5 degrees and 0.6 degrees respectively, and aggravated after surgery (0.9 degrees and 4.9 degrees, respectively). Both the UIVDA and LIVDA were significantly aggravated at the final follow-up (3.0 degrees and 7.8 degrees, respectively). The sagittal contours of T(5-12) and T(10)-L(2) were well maintained after surgery and at the final follow-up. The lumbar lordosis of L(1)-S(1) and the sagittal Cobb angle of the instrumented segments were reduced postoperatively and at the final follow-up. No pseudarthrosis or other complications were observed.
Selective anterior TL/L fusion with single solid rod instrumentation is effective and safe for AIS with PUMCIId1 (Lenke type 5) curves, above and below the fusion and larger residual thoracic curve in some cases need further evaluated.
评估选择性胸腰段或腰段（TL/L）前路融合术治疗青少年特发性脊柱侧凸（AIS）合并PUMCIId1型曲线（Lenke 5型）的疗效。
回顾性分析35例连续接受选择性胸腰段或腰段前路单棒内固定融合术的AIS患者（PUMC II d1型，Lenke 5型）。平均随访36个月（范围18 - 42个月）。测量并分析站立位前后位和侧位X线片。
TL/L曲线术前平均Cobb角为45.6°，术后矫正至9.7°，曲线矫正率为79.7%。胸段曲线术前29.7°，术后降至17.6°，自发矫正率为41.5%。末次随访时，TL/L曲线和胸段曲线平均分别有4.7°和2.5°的矫正丢失。躯干偏移术前14.0 mm，术后略有恶化至14.8 mm，末次随访时显著改善至5.1 mm。最低融合椎体（LIV）倾斜度术后显著改善（术前-21.8°，术后-1.5°），末次随访时维持良好（-2.1°）。上融合椎体上方（UIVDA）和LIV下方（LIVDA）的冠状位椎间盘角平均分别为0.5°和0.6°，术后加重（分别为0.9°和4.9°）。末次随访时UIVDA和LIVDA均显著加重（分别为3.0°和7.8°）。T(5 - 12)和T(10) - L(2)的矢状面轮廓术后及末次随访时维持良好。L(1) - S(1)的腰椎前凸及融合节段的矢状面Cobb角术后及末次随访时均减小。未观察到假关节或其他并发症。
选择性胸腰段或腰段前路单棒内固定融合术治疗AIS合并PUMCIId1（Lenke类型5）曲线有效且安全，融合节段上下及部分病例较大残留胸段曲线仍需进一步评估。
