选择性前路胸腰椎/腰椎融合及内固定术治疗青少年特发性脊柱侧凸。

Selective anterior thoracolumbar/lumbar fusion and instrumentation in adolescent idiopathic scoliosis patients.

机构信息

Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.

出版信息

Chin Med J (Engl). 2010 Nov;123(21):3003-8.

PMID:21162946

Abstract

BACKGROUND

Selective anterior thoracolumbar/lumbar (TL/L) fusion and instrumentation in adolescent idiopathic scoliosis (AIS) patients with a structural major TL/L curve and a nonstructural minor thoracic curve is rarely reported. We investigate the correction results of these patients.

METHODS

By reviewing the medical records and roentgenograms of AIS patients undergone selective anterior TL/L fusion and instrumentation, Cobb angle, correction rate of the major and minor curves, coronal balance, lowest instrumented vertebra (LIV) tilt, coronal disc angle immediately below the LIV (LIVDA) and radiographic shoulder height (RSH) were measured and analyzed.

RESULTS

Forty patients were included. For the major TL/L curve, the mean coronal Cobb angle before and after operation were 43.9° and 8.7°, respectively, with an average correction rate of 80.2% (P = 0.000). While for the minor thoracic curve, the mean coronal Cobb angle before and after operation were 27.2° and 14.3°, respectively, with an average spontaneous correction rate of 47.4% (P = 0.000). At final follow-up, the coronal Cobb angles of the major and minor curves were 13.7° and 17.1°, respectively, with a mean correction loss of 5.0° and 2.9°, respectively. The coronal balance before and after operations was 13.2 mm and 11.5 mm, respectively. At the final follow-up, it turned to 5.6 mm, which was much better than that after operation (P = 0.001). The mean LIV tilt was 23.5° before operation, and was significantly improved after operation (8.3°, P = 0.000). At final follow-up, it was well maintained (10.6°). The LIVDA averaged 3.5° before operation, and aggravated to 5.5° after operation (P = 0.100) and 7.4° at final follow-up (P = 0.012), respectively. The RSH was 7.3 mm before operation, 5.6 mm after operation, and 2.2 mm at the final follow-up. The RSH at the final follow-up was significantly improved compared with that after operation (P = 0.002).

CONCLUSIONS

Selective anterior TL/L fusion and instrumentation can get good correction results of both curves, with good results of the coronal balance and RSH in AIS patients, while a larger LIVDA.

摘要

背景

在伴有结构性主胸腰/腰椎（TL/L）曲线和非结构性次要胸椎曲线的青少年特发性脊柱侧凸（AIS）患者中，选择性前路 TL/L 融合和内固定术很少报道。我们研究了这些患者的矫正结果。

方法

通过回顾 AIS 患者接受选择性前路 TL/L 融合和内固定术的病历和 X 线片，测量并分析主 TL/L 曲线和次要胸椎曲线的 Cobb 角、主要和次要曲线的矫正率、冠状平衡、最低固定椎（LIV）倾斜度、LIV 下方的椎间盘角（LIVDA）和放射学肩高（RSH）。

结果

共纳入 40 例患者。对于主 TL/L 曲线，术前和术后的冠状 Cobb 角分别为 43.9°和 8.7°，平均矫正率为 80.2%（P=0.000）。而对于次要胸椎曲线，术前和术后的冠状 Cobb 角分别为 27.2°和 14.3°，平均自发性矫正率为 47.4%（P=0.000）。末次随访时，主、次胸腰椎曲线的冠状 Cobb 角分别为 13.7°和 17.1°，平均矫正丢失分别为 5.0°和 2.9°。术前和术后的冠状平衡分别为 13.2mm 和 11.5mm，末次随访时为 5.6mm，明显优于术后（P=0.001）。术前 LIV 倾斜度平均为 23.5°，术后明显改善（8.3°，P=0.000）。末次随访时，保持良好（10.6°）。术前 LIVDA 平均为 3.5°，术后加重至 5.5°（P=0.100），末次随访时加重至 7.4°（P=0.012）。术前 RSH 为 7.3mm，术后为 5.6mm，末次随访时为 2.2mm。末次随访时的 RSH 明显优于术后（P=0.002）。