Korovessis P, Filos K S, Zielke K
German Scoliosis Center, Bad Wildungen.
Spine (Phila Pa 1976). 1995 May 1;20(9):1061-7. doi: 10.1097/00007632-199505000-00013.
This study analyzed the changes in the frontal plane of the deformed lower rib cage and the scoliosis-related alterations on the spine in patients with double major curve-pattern idiopathic scoliosis.
The results obtained preoperatively, after the Zielke operation, postoperatively after the Harrington instrumentation, and at the follow-up evaluation were compared to investigate which changes of the elements of the rib cage deformity are caused by each of the two instrumentations.
Previously, Wojcik reported on the effects of a Zielke operation on the lower rib in mild S-shaped idiopathic scoliosis. No previous data exist regarding the lower rib cage deformities in severe idiopathic double major-pattern scoliosis and their changes after combined VDS-Zielke and Harrington instrumentation.
Fifteen patients who underwent the staged Zielke operation followed by Harrington rod instrumentation were followed-up for an average period of 31.1 months. The methods used in our study included Cobb angle and a segmental analysis (T7-T12) of each of convex and concave rib-vertebra angles, rib-vertebra angle differences, vertebral rotation, and vertebral tilt.
In this series, the apical convex ribs showed an increased droop preoperatively compared with the concave apical ribs. The VDS-Zielke operation corrected the lumbar scoliosis in an average of 63% of patients, whereas the thoracic scoliosis showed an immediate spontaneous correction of 30%. The VDS-Zielke operation also produced a significant correlation of the scoliosis-related vertebral tilt (T10-T12), derotated the lumbar vertebrae and the T12 vertebra significantly, elevated the "mobile" concave ribs, and increased the droop of the lower (T11, T12) "mobile" convex ribs. The Harrington instrumentation did not change the vertebral rotation, the vertebral tilt, the convex rib-vertebra angle, or the L4 obliquity, but significantly changed the apical concave rib-vertebra angle. The combined Zielke-Harrington instrumentation reduced the thoracic kyphosis and the thoracolumbar junction-kyphosis significantly, whereas the lumbar lordosis remained practically unchanged.
Only the anterior VDS-Zielke instrumentation significantly corrects severe spinal deformities, elevates the three lower ribs on the concavity, and increases the droop of the two lower ribs on the convexity in the severe idiopathic double major curve-pattern scoliosis combined operated (Zielke-Harrington). Therefore, the Harrington instrumentation should have only limited use in cosmetic scoliosis surgery and should be replaced with posterior multi-hook instrumentation with a derotation effect.
本研究分析了双主弯型特发性脊柱侧凸患者变形的下胸廓额状面变化以及脊柱上与脊柱侧凸相关的改变。
比较术前、齐尔克手术（Zielke operation）后、哈灵顿器械固定术后以及随访评估时获得的结果，以研究两种器械固定方式分别导致胸廓畸形各要素发生了哪些变化。
此前，沃伊奇克（Wojcik）报道了齐尔克手术对轻度S型特发性脊柱侧凸下肋骨的影响。关于重度特发性双主弯型脊柱侧凸的下胸廓畸形及其在VDS - 齐尔克和哈灵顿联合器械固定后的变化，此前尚无相关数据。
对15例行分期齐尔克手术并随后行哈灵顿棒器械固定的患者进行了平均31.1个月的随访。我们研究中使用的方法包括Cobb角以及对每个凸侧和凹侧肋椎角、肋椎角差异、椎体旋转和椎体倾斜度进行节段分析（T7 - T12）。
在该系列中，术前顶椎凸侧肋骨相较于凹侧顶椎肋骨下垂增加。VDS - 齐尔克手术平均矫正了63%患者的腰椎侧凸，而胸椎侧凸立即自发矫正了30%。VDS - 齐尔克手术还使与脊柱侧凸相关的椎体倾斜度（T10 - T12）产生了显著相关性，使腰椎椎体和T12椎体明显去旋转，抬高了“活动”的凹侧肋骨，并增加了下方（T11、T12）“活动”凸侧肋骨的下垂度。哈灵顿器械固定未改变椎体旋转、椎体倾斜度、凸侧肋椎角或L4倾斜度，但显著改变了顶椎凹侧肋椎角。齐尔克 - 哈灵顿联合器械固定显著降低了胸椎后凸和胸腰段交界处后凸，而腰椎前凸基本保持不变。
在重度特发性双主弯型脊柱侧凸联合手术（齐尔克 - 哈灵顿）中，只有前路VDS - 齐尔克器械固定能显著矫正严重脊柱畸形，抬高凹侧下方三根肋骨，并增加凸侧下方两根肋骨的下垂度。因此，哈灵顿器械固定在美容性脊柱侧凸手术中的应用应仅局限，应被具有去旋转效果的后路多钩器械固定所取代。
