Osebold W R, Mayfield J K, Winter R B, Moe J H
J Bone Joint Surg Am. 1982 Jul;64(6):841-56.
The spines of forty patients with myelomeningocele and paralytic scoliosis were surgically stabilized at the Twin Cities Scoliosis Center between 1960 and 1979. Treatment with posterior spine fusion and Harrington instrumentation extending to the sacrum, combined with anterior fusion using either Dwyer or Zielke instrumentation, gave the best results, correcting scoliosis by an average of 45 degrees (comparing preoperative values with those at the last visit), lordosis by an average of 20 degrees, torso decompensation by an average of 5.7 centimeters, and pelvic obliquity by an average of 7 degrees. This combined fusion method reduced the rate of pseudarthrosis to 23 per cent (compared with 46 per cent when only posterior fusion and instrumentation were used). Prophylactic antibodies (selected on the basis of preoperative cultures of urine) reduced the infection rate to 8 per cent. Posterior fusion or anterior fusion alone was inadequate, even with instrumentation. Early mobilization wearing a bivalved polypropylene body jacket minimized osteoporosis, pressure sores, and social isolation. Unsolved technical problems remain, however, especially in relation to obtaining fusion across the lumbosacral joint.
1960年至1979年间，明尼阿波利斯双子城脊柱侧弯中心对40例患有脊髓脊膜膨出和麻痹性脊柱侧弯的患者进行了脊柱手术固定。采用后脊柱融合术和延伸至骶骨的哈灵顿器械进行治疗，并结合使用Dwyer或Zielke器械进行前路融合，效果最佳，平均矫正脊柱侧弯45度（将术前值与最后一次随访时的值进行比较），平均矫正脊柱前凸20度，平均矫正躯干失代偿5.7厘米，平均矫正骨盆倾斜7度。这种联合融合方法将假关节形成率降低至23%（仅使用后融合术和器械时为46%）。预防性抗体（根据术前尿培养结果选择）将感染率降低至8%。单独进行后融合术或前路融合术是不够的，即使使用了器械也是如此。早期佩戴双瓣聚丙烯身体夹克进行活动，可将骨质疏松、压疮和社交隔离的风险降至最低。然而，尚未解决的技术问题仍然存在，尤其是在实现腰骶关节融合方面。
