Lapinksy A S, Richards B S
Texas Scottish Rite Hospital, Dallas, USA.
Spine (Phila Pa 1976). 1995 Jun 15;20(12):1392-8.
Fourteen skeletally immature patients with idiopathic scoliosis (Group I) were retrospectively studied to determine if the crankshaft phenomenon was prevented by combining anterior spinal fusion with posterior instrumentation and fusion. They were compared with 12 similar patients who underwent posterior procedures only (Group II).
To determine whether the addition of anterior spinal fusion was beneficial in preventing progressive spinal deformity in the very young patient.
The crankshaft phenomenon had been well documented in young patients undergoing posterior fusion only. No previous study compared the results of a similar group of patients some of whom underwent combined anterior and posterior fusion and the others who underwent posterior fusion only.
Patients who were Risser O and had open triradiate cartilages at surgery were evaluated for curve correction, correction loss, changes in rib vertebral angle differences, rotational changes, and spinal balance. Crankshaft was defined as a progression in curve magnitude greater than 10 degrees and accompanied by an increase in rib vertebral angle difference greater than 10 degrees. In Group I, age at surgery averaged 10.7 years, and follow-up averaged 37 months. In Group II, age at surgery averaged 11.0 years, and follow-up averaged 64 months.
Group I: Thoracic curve correction averaged 77% after surgery and 68% at follow-up. At follow-up, two patients had curves progress more than 10 degrees, and three patients had an increase in rib vertebral angle difference of 10 degrees or more, but none of the patients had these changes simultaneously. Group II: During the course of follow-up, five of the 12 patients had progressive changes of 10 degrees or more in curve size and rib vertebral angle difference. Four other patients had an increase exceeding 10 degrees in one of the two categories.
In skeletally immature children (open triradiate cartilage and Risser O) with idiopathic scoliosis, the addition of anterior spinal fusion to posterior instrumentation and fusion is helpful in preventing the crankshaft phenomenon.
对14例骨骼未成熟的特发性脊柱侧凸患者（第一组）进行回顾性研究，以确定前路脊柱融合联合后路内固定及融合是否能预防曲轴现象。将他们与12例仅接受后路手术的类似患者（第二组）进行比较。
确定前路脊柱融合术对预防极年轻患者脊柱畸形进展是否有益。
曲轴现象在仅接受后路融合术的年轻患者中已有充分记录。此前尚无研究比较过一组类似患者的结果，其中部分患者接受了前后路联合融合术，另一部分仅接受了后路融合术。
对手术时Risser O级且三骨骺软骨开放的患者进行曲线矫正、矫正丢失、肋椎角差异变化、旋转变化及脊柱平衡评估。曲轴现象定义为曲线度数进展大于10度且肋椎角差异增加大于10度。第一组患者手术时平均年龄为10.7岁，平均随访37个月。第二组患者手术时平均年龄为11.0岁，平均随访64个月。
第一组：术后胸椎曲线平均矫正率为77%，随访时为68%。随访时，2例患者曲线进展超过10度，3例患者肋椎角差异增加10度或更多，但无患者同时出现这些变化。第二组：在随访过程中，12例患者中有5例曲线大小和肋椎角差异出现10度或更大的进展性变化。另外4例患者在这两个类别中的一项增加超过10度。
在骨骼未成熟（三骨骺软骨开放且Risser O级）的特发性脊柱侧凸儿童中，前路脊柱融合联合后路内固定及融合有助于预防曲轴现象。
