Renshaw T S
Newington Children's Hospital, Connecticut.
Orthop Clin North Am. 1988 Apr;19(2):257-67.
The Harrington instrumentation system was the first widely used, internationally accepted internal fixation system for the correction of idiopathic scoliosis when combined with a spinal arthrodesis. It has been generally available to the orthopedic surgeon for more than 25 years, and therefore its capabilities and limitations have been identified through this long experience. Its implantation requires minimal invasion of the spinal canal and is associated with a low (less than 0.5 per cent) incidence of neurologic complications. It provides predictable correction of spinal deformity with little subsequent loss of correction. When compared with other newer, more complex internal fixation systems for spinal deformities, the Harrington system has a shorter, less difficult "learning curve"; requires less operating time and blood loss to insert; implants a smaller mass of metal; and in some cases costs substantially less for the implant system. The Harrington system has an extremely low incidence of hook dislodgment and pseudoarthrosis formation in single thoracic curves, being reported as near zero for these curves in two recently published series. Conversely, there are some disadvantages to the Harrington system when compared with other types of fixation. It has limited ability to provide sagittal plane control. It does not effectively and predictably derotate the spine. A recent study showed that at an average of 4 years postoperatively, nearly two thirds of the patients had an actual increase in their rib prominence. The pseudoarthrosis rate is high, up to 4 per cent, in the thoracolumbar and lumbar spine. Hook dislodgment approaches 3 per cent when used below the thoracic region. Another disadvantage is the necessity for postoperative external support. As a result, the Harrington system remains an excellent means of treating single and double thoracic idiopathic curves in a safe and predictable manner, while admittedly having limited derotation and sagittal plane control. Other systems that are more sophisticated at segmental fixation of the spine appear to be more appropriate for scoliotic deformities requiring fusion of the thoracolumbar or lumbar spine and those associated with significant sagittal plane deformities.
哈灵顿器械系统是首个广泛应用且被国际认可的用于矫正特发性脊柱侧凸并结合脊柱融合术的内固定系统。它已普遍可供骨科医生使用超过25年，因此通过这段漫长的经验，其能力和局限性已被明确。其植入对椎管的侵入最小，且神经并发症发生率低（低于0.5%）。它能对脊柱畸形进行可预测的矫正，且后续矫正丢失很少。与其他更新、更复杂的脊柱畸形内固定系统相比，哈灵顿系统的“学习曲线”更短、难度更低；植入所需的手术时间和失血量更少；植入的金属量更小；在某些情况下，植入系统的成本大幅降低。哈灵顿系统在单胸弯中钩移位和假关节形成的发生率极低，在最近发表的两个系列研究中，这些弯的发生率接近零。相反，与其他类型的固定相比，哈灵顿系统存在一些缺点。它提供矢状面控制的能力有限。它不能有效且可预测地使脊柱去旋转。最近一项研究表明，术后平均4年时，近三分之二的患者肋骨隆起实际增加。在胸腰段和腰椎，假关节发生率高达4%。在胸段以下使用时，钩移位接近3%。另一个缺点是术后需要外部支撑。因此，哈灵顿系统仍然是以安全且可预测的方式治疗单胸弯和双胸弯特发性脊柱侧凸的极佳方法，尽管其去旋转和矢状面控制能力有限。其他在脊柱节段固定方面更复杂的系统似乎更适合需要胸腰段或腰椎融合以及伴有明显矢状面畸形的脊柱侧凸畸形。
