Kandwal Pankaj, Goswami Ankur, Vijayaraghavan G, Subhash K R, Jaryal Ashok, Upendra B N, Jayaswal Arvind
Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India.
Spine Deform. 2016 Jul;4(4):296-303. doi: 10.1016/j.jspd.2015.12.005. Epub 2016 Jun 16.
Severe rigid curves present a big challenge to the treating spine surgeon. We evaluated the outcome of staged anterior release and posterior instrumentation for rigid scoliosis.
Twenty-one patients with an average age of 14.4 years (range 11-17) having a rounded severe rigid scoliosis (Cobb angle >100 degrees) underwent surgical correction. Six patients had congenital scoliosis, 13 idiopathic scoliosis, and 2 syndromic. All patients underwent anterior release in Stage I with one or more Ponte osteotomies and in Stage II with all pedicle screw instrumentation, and 13 of the patients underwent an asymmetric pedicle subtraction osteotomy at the apex. Patients were assessed for deformity correction, operative time, blood loss, and any complications.
The preoperative Cobb angle of 116.6 degrees (range 101-124 degrees) improved to 74.0 degrees (range 54-86 degrees) after anterior release: 29.4% correction and the final postoperation Cobb angle after posterior instrumentation was 26.5 degrees (range 22-32 degrees), with final 76% correction. The average blood loss in anterior release was 585.95 mL (range 400-980 mL; % estimated blood volume = 19.5%), whereas the mean operative time was 223 minutes (165-315 minutes). One patient had prolonged chest drain and two, basal atelectasis following anterior release. The mean operative time for the posterior procedure was 340 minutes (range 280-420 minutes) and average blood loss was 2,066 mL (range 1,200-3,200 mL). The mean apical axial rotation of 56 degrees (range 26-79 degrees) improved to 28 degrees (range 9-42 degrees) (p < .05). There was loss of motor evoked potential signal in one and hook pullout, superficial infection, and local skin necrosis one case each.
The staged approach to the management of severe, rigid scoliosis helps get an excellent correction. Anterior release loosens up the rigid apex and provides with nearly 30% correction so that the extent of the osteotomies in the second stage from the back is substantially reduced, allowing for a final good correction.
严重僵硬的脊柱侧弯曲线给脊柱外科医生的治疗带来了巨大挑战。我们评估了分期前路松解和后路内固定治疗僵硬型脊柱侧弯的疗效。
21例平均年龄14.4岁（11 - 17岁）的严重僵硬型圆形脊柱侧弯（Cobb角>100度）患者接受了手术矫正。其中6例为先天性脊柱侧弯，13例为特发性脊柱侧弯，2例为综合征性脊柱侧弯。所有患者在第一阶段均接受了一次或多次Ponte截骨的前路松解，在第二阶段接受了全椎弓根螺钉内固定，13例患者在顶椎处进行了不对称椎弓根截骨术。对患者进行了畸形矫正、手术时间、失血量及任何并发症的评估。
前路松解后，术前Cobb角116.6度（101 - 124度）改善至74.0度（54 - 86度），矫正率为29.4%；后路内固定术后最终Cobb角为26.5度（22 - 32度），最终矫正率为76%。前路松解平均失血量为585.95 mL（400 - 980 mL；估计血容量百分比 = 19.5%），而平均手术时间为223分钟（165 - 315分钟）。1例患者胸腔引流时间延长，2例患者前路松解后出现基底肺不张。后路手术平均手术时间为340分钟（280 - 420分钟），平均失血量为2066 mL（1200 - 3200 mL）。平均顶椎轴向旋转56度（26 - 79度）改善至28度（9 - 42度）（p <.05）。1例患者运动诱发电位信号消失，1例出现钩拔出、浅表感染和局部皮肤坏死。
分期治疗严重僵硬型脊柱侧弯有助于获得良好的矫正效果。前路松解可松解僵硬的顶椎，提供近30%的矫正，从而大幅减少第二阶段后路截骨的范围，实现最终良好的矫正。
