Onimus M, Laurain J M
Service de Chirurgie des Scolioses et d'Orthopédie Infantile, Centre Hospitalier Régional et Universitaire, Besançon.
Rev Chir Orthop Reparatrice Appar Mot. 1987;73(5):349-60.
The Hartshill rectangle, a metal frame fixed to the laminae by sublaminar wires, has been used in 50 cases. Twenty idiopathic adolescent scolioses have been corrected from 49.3 degrees to 24.7 degrees with excellent stability of the curve at six and twelve months follow-up. Twelve paralytic scolioses were corrected from 71 degrees to 34.7 degrees but, in nine cases, the associated pelvic obliquity was not appreciably altered. Eleven adult scolioses, with an age range between 20 and 68 years, were corrected from 66.3 degrees to 38.7 degrees by a two-stage procedure of anterior release followed by posterior fixation with a Hartshill frame. In six patients with spinal metastases the Hartshill frame was used to provide spinal stability. The segmental fixation gave immediate post-operative comfort and allowed the patient to mobilise early without bracing. There were transient neurological complications--three cases of cutaneous hyperaesthesiae and one of monoparesis of a lower limb. Failure of the apparatus was encountered in cases of severe deformity with bending of the metal of the rectangle in two cases, breakage of distal wires in three cases and slipping of wires on the frame in two cases. The Hartshill frame provides stable fixation of the spine. It produces a three-dimensional correction of the scoliosis with preservation of reformation of the normal physiological kyphosis and lordosis. It is indicated for the correction of sagittal deformities, particularly in older patients and adults with thoracolumbar or lumbar curves and for spinal instability, especially in cases of destruction of posterior bony and ligamentous elements of the spine.
哈特希尔矩形架是一种通过椎板下钢丝固定在椎板上的金属框架，已应用于50例患者。20例特发性青少年脊柱侧凸患者的侧弯角度从49.3度矫正至24.7度，在术后6个月和12个月随访时曲线稳定性良好。12例麻痹性脊柱侧凸患者的侧弯角度从71度矫正至34.7度，但9例患者的相关骨盆倾斜度未得到明显改善。11例年龄在20至68岁之间的成人脊柱侧凸患者，通过前路松解联合哈特希尔框架后路固定的两阶段手术，侧弯角度从66.3度矫正至38.7度。6例脊柱转移瘤患者使用哈特希尔框架以提供脊柱稳定性。节段性固定在术后立即带来舒适感，并使患者无需支具即可早期活动。出现了短暂的神经并发症——3例皮肤感觉过敏和1例下肢单瘫。在严重畸形的病例中出现了器械故障，其中2例矩形架金属弯曲，3例远端钢丝断裂，2例钢丝在框架上滑动。哈特希尔框架能提供稳定的脊柱固定。它能对脊柱侧凸进行三维矫正，同时保留正常生理后凸和前凸的重建。它适用于矢状面畸形的矫正，特别是在老年患者以及患有胸腰段或腰段侧弯的成人患者中，也适用于脊柱不稳定的情况，尤其是在脊柱后部骨质和韧带结构遭到破坏的病例中。
