Lee Choon Sung, Hwang Chang Ju, Kim Dong-Joon, Kwon Joon, Kim Yung-Tae, Lee Mi Young, Yoon So Jung, Lee Dong-Ho
*Scoliosis Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; ‡Department of Orthopaedic Surgery, Bumin Hospital, Busan, Korea.
Neurosurgery. 2014 Jan;74(1):35-41; discussion 41. doi: 10.1227/NEU.0000000000000194.
Although effective correction of deformity in congenital scoliosis can often be achieved with instrumentation only and without more invasive techniques such as hemivertebrectomy (HV), reports of the feasibility of correction with instrumentation only (IO) are lacking.
To compare the results of deformity correction using IO vs HV and to examine the feasibility of and indications for correction with IO in patients with congenital scoliosis.
Twenty-five patients underwent correction with either IO (n = 14) or HV (n = 11). The 2 patient groups were compared in terms of age at the time of surgery, preoperative magnitude and flexibility of the main curve, correction rates after surgery and at the final follow-up, surgery time, estimated blood loss, and complications.
The 2 groups did not differ significantly in terms of average patient age or curve magnitude, but the correction with the IO group had greater preoperative curve flexibility (37.1%) than the HV group (21.0%). The correction rates immediately after surgery were high in both groups. The correction with IO group had a shorter mean operation time (308 minutes vs 366 minutes) and less blood loss (540 mL vs 1547 mL) than the HV group.
Satisfactory correction of congenital scoliosis can be obtained with IO if there is adequate flexibility in the main curve, thus avoiding the need for more invasive procedures such as HV.
尽管先天性脊柱侧凸畸形通常仅通过器械植入即可有效矫正,无需诸如半椎体切除术(HV)等更具侵入性的技术,但仅使用器械植入(IO)进行矫正的可行性报告却很缺乏。
比较使用IO与HV进行畸形矫正的结果,并探讨先天性脊柱侧凸患者采用IO矫正的可行性及适应证。
25例患者接受了IO(n = 14)或HV(n = 11)矫正。比较两组患者手术时的年龄、术前主弯的严重程度和柔韧性、术后及末次随访时的矫正率、手术时间、估计失血量及并发症。
两组患者的平均年龄或侧弯严重程度无显著差异,但IO组术前侧弯柔韧性(37.1%)高于HV组(21.0%)。两组术后即刻矫正率均较高。IO组的平均手术时间(308分钟对366分钟)比HV组短,失血量(540 mL对1547 mL)也比HV组少。
如果主弯有足够的柔韧性,采用IO可获得令人满意的先天性脊柱侧凸矫正效果,从而避免了诸如HV等更具侵入性手术的需要。