Postgraduate Medical School, General Hospital of People's Liberation Army, Beijing 100853, China.
Chin Med J (Engl). 2012 Jan;125(1):81-6.
Although previous reports had reported the use of temporary internal distraction as an aid to correct severe scoliosis, two-stage surgery strategy (less invasive internal distraction followed by posterior correction and instrumentation) has never been reported in the treatment of patients with severe spinal deformity. This study aimed to report the results of the surgical treatment of severe scoliosis and kyphoscoliosis by two-stage and analyse the safety and efficacy of this surgical strategy in the treatment of severe spinal deformities.
A total of 15 patients with severe scoliosis, kyphoscoliosis or kyphosis who underwent two-stage surgeries (less invasive internal distraction followed by posterior correction and instrumentation) were studied based on hospital records. Pretreatment radiographs and radiographs taken after first surgery (internal distraction by two small incisions), before second surgery (posterior correction, instrumentation and fusion), one week after second surgery and final follow-up were measured. Subjects were analyzed by age, gender, major coronal curve magnitude, flexibility of major curve, major sagittal curve magnitude before first surgery, after first surgery, before second surgery, after second surgery and at final follow-up. Complications related to two-stage surgeries were noted in each case.
The average major curve magnitude was 129.4° (range, 95° to 175°), reduced 58.9° or 45.4% after first stage surgery and reduced 30.6° or 24.6% after second stage surgery. The loss of correction during the interval between two surgeries was 7.1%. The total major coronal curve correction was 81.4° or 62.9%. At the final follow up, the average loss of correction of major coronal curve was 3.9° and the final average correction rate was 59.7%. The average major sagittal curve magnitude was 80.3° (range, 30° to 170°), and the total major sagittal curve correction was 48.2°. Loss of correction averaged 4.0° for major sagittal curve and the final correction averaged 42.2°. Clinical complications were noted in the peri-operative and long-term periods.
Two-stage surgery was a safe and effective surgical strategy in this difficult population. Using two-small-incision technique, the first stage surgery was less invasive. No permanent neurologic deficit was noted in this series.
尽管之前的报告已经报道了使用临时内部分散作为辅助手段来矫正严重脊柱侧凸，但两阶段手术策略（微创内部分散，然后进行后路矫正和内固定）从未用于治疗严重脊柱畸形患者。本研究旨在报告两阶段手术治疗严重脊柱侧凸和后凸畸形的结果，并分析该手术策略治疗严重脊柱畸形的安全性和有效性。
根据病历资料，对 15 例严重脊柱侧凸、后凸或后凸患者进行两阶段手术（微创内部分散，然后进行后路矫正和内固定）治疗。测量术前和首次手术后（经两个小切口进行内部分散）、第二次手术前（后路矫正、内固定和融合）、第二次手术后一周和最终随访时的影像学资料。分析患者的年龄、性别、主要冠状面曲线幅度、主要曲线柔韧性、首次手术前、首次手术后、第二次手术前、第二次手术后和最终随访时的主要矢状面曲线幅度。记录每例与两阶段手术相关的并发症。
平均主要曲线幅度为 129.4°（范围为 95°至 175°），第一次手术后降低 58.9°或 45.4%，第二次手术后降低 30.6°或 24.6%。两次手术之间的矫正丢失为 7.1%。总主要冠状面曲线矫正率为 81.4°或 62.9%。最终随访时，主要冠状面曲线矫正丢失平均为 3.9°，最终平均矫正率为 59.7%。平均主要矢状面曲线幅度为 80.3°（范围为 30°至 170°），总主要矢状面曲线矫正率为 48.2°。主要矢状面曲线矫正丢失平均为 4.0°，最终矫正平均为 42.2°。在围手术期和长期随访期间观察到临床并发症。
在这一困难人群中，两阶段手术是一种安全有效的手术策略。使用两小切口技术，第一阶段手术的侵袭性较小。本系列研究中未出现永久性神经功能缺损。
