Potaczek Tomasz, Jasiewicz Barbara, Tesiorowski Maciej, Zarzycki Daniel, Szcześniak Andrzej
Department of Orthopaedics and Rehabilitation, Faculty of Medicine, School of Medicine, Jagiellonian University.
Ortop Traumatol Rehabil. 2009 Nov-Dec;11(6):485-94.
The treatment of scoliosis exceeding 100 degrees remains a challenge. Anterior fusion only may lead to low correction and screw plowing, posterior fusion only may cause the cranckshaft phenomenon in skeletally immature patients. Two-stage surgery is advocated, comprising anterior release and posterior fusion.
The aim of the paper is to compare treatment outcomes in patients with a >100% primary curve treated between 1984 - 2004 with one of the following techniques: halo-femoral traction with posterior fusion (Group I; n=124 patients), anterior release with halo-femoral traction and posterior fusion (Group II; n=32), single stage anterior release and posterior fusion (Group III; n=20), and posterior fusion only (Group IV; n=19). Correction and loss of correction were assessed radiologically. Additional surgical procedures and the presence of complications were also recorded. The fusion techniques were compared. Mean post-operative follow-up duration was 3.9 years, ranging from 2 to 15.3 years.
Correction was highest in Group II and Group III (52.7% and 51.7%, respectively); vs. Group I and Group IV (45.8% and 38.7%, respectively). The loss of correction at final follow-up was lowest in Group II and Group III (2% and 3.3%), and highest in Group I and Group IV (6.4% and 15.6%, p<0.05). In all groups, the use of derotational instrumentation increased correction (59.7% C-D vs. 37% Wisconsin vs. 24.5% Harrington-Luque) and decreased loss of correction (4% C-D vs. 5% Harrington-Luque vs. 28% Wisconsin). Rates of neurological complications were similar in all groups; no persistent deficits were noted.
Anterior release with halo traction and posterior fusion is the optimal treatment of severe scoliosis. If halo traction is contraindicated, single stage anterior release and posterior fusion should be performed. Contemporary instrumentation techniques result in higher correction rates and better curve stability.
治疗超过100度的脊柱侧弯仍然是一项挑战。单纯前路融合可能导致矫正不足和螺钉穿出，单纯后路融合可能在骨骼未成熟的患者中引起曲轴现象。提倡采用两阶段手术，包括前路松解和后路融合。
本文旨在比较1984年至2004年间采用以下技术之一治疗的主弯>100°患者的治疗结果：头-股牵引联合后路融合（I组；n = 124例患者）、前路松解联合头-股牵引及后路融合（II组；n = 32例）、一期前路松解和后路融合（III组；n = 20例）以及单纯后路融合（IV组；n = 19例）。通过影像学评估矫正和矫正丢失情况。还记录了额外的手术操作和并发症的发生情况。对融合技术进行了比较。术后平均随访时间为3.9年，范围为2至15.3年。
II组和III组的矫正率最高（分别为52.7%和51.7%）；相比之下，I组和IV组分别为45.8%和38.7%。最终随访时矫正丢失率在II组和III组最低（分别为2%和3.3%），在I组和IV组最高（分别为6.4%和15.6%，p<0.05）。在所有组中，使用去旋转器械可提高矫正率（C-D为59.7%，威斯康星为37%，哈灵顿-卢克为24.5%）并降低矫正丢失率（C-D为4%，哈灵顿-卢克为5%，威斯康星为28%）。所有组的神经并发症发生率相似；未发现持续性神经功能缺损。
头牵引联合前路松解及后路融合是重度脊柱侧弯的最佳治疗方法。如果头牵引禁忌，则应进行一期前路松解和后路融合。当代器械技术可提高矫正率并改善曲线稳定性。
