Halm H, Liljenqvist U, Castro W H, Jerosch J
Department of Orthopedic Surgery, Westfälische Wilhelms University Münster, Germany.
Acta Orthop Belg. 1995;61(4):286-93.
The advantages of VDS according to Zielke with excellent 3-dimensional correction and shorter fusion levels in comparison to posterior instrumentation techniques are well known. A disadvantage is the necessity of long postoperative immobilization in a body cast or brace due to lack of primary stability. The aim of the VDS double-rod instrumentation is augmentation of the system with the possibility of postoperative treatment without plaster cast or braces. Following thoracolumbophrenotomy and ligation of the segmental vessels double-hole vertebra clamps are inserted. First VDS screws are placed in the posterior holes of these plates. With a 4-mm threaded compression rod correction is obtained by centripetal compressive forces on the nuts. Next VDS screws for the 5-mm threaded rod are inserted into the anterior holes of the vertebral clamps. The rod is implanted in a slightly compressive manner and augments the system. In a prospective study 8 patients, 4 with idiopathic and 4 with neuromuscular scoliotic deformities, underwent this surgical procedure and now have a follow-up of 2 years. Curves ranged from 45 degrees to 131 degrees Cobb angle. All patients were treated without plaster casts or braces postoperatively, but with only a semielastic vest for 4 to 6 months. Unusual intra- and postoperative complications have not been noted. Correction of the primary curve averaged 69.4% at follow-up. Tilt of the caudal end vertebra was corrected 75% to an average of 6.3 degrees. Spontaneous partial correction of the upper secondary curve was noted in all cases. Rod fracture of the 5-mm rod without fracture of the 4-mm rod at this level was seen in 1 patient without loss of correction. Solid fusion was achieved at every level in all patients. The sagittal plane was not adversely affected by the instrumentation. However, larger patient numbers and a longer follow-up are necessary.
与后路器械技术相比，Zielke提出的椎体去旋转系统（VDS）具有出色的三维矫正效果且融合节段更短，其优势众所周知。一个缺点是由于缺乏初始稳定性，术后需要长时间使用石膏背心或支具固定。VDS双棒器械的目的是增强该系统，使术后无需使用石膏或支具进行治疗。经胸腰段开胸及节段血管结扎后，插入双孔椎体夹。首先将VDS螺钉置入这些钢板的后孔。使用4毫米带螺纹的加压棒，通过螺母上的向心压缩力进行矫正。接下来，将用于5毫米螺纹杆的VDS螺钉插入椎体夹的前孔。以轻微加压的方式植入杆，增强系统。在一项前瞻性研究中，8例患者（4例特发性脊柱侧凸和4例神经肌肉性脊柱侧凸畸形患者）接受了该手术，目前随访2年。Cobb角范围为45度至131度。所有患者术后均未使用石膏或支具，仅佩戴半弹性背心4至6个月。未发现异常的术中及术后并发症。随访时主弯平均矫正率为69.4%。尾端椎体的倾斜矫正了75%，平均为6.3度。所有病例均发现上侧凸有自发的部分矫正。1例患者出现5毫米杆骨折，而该水平的4毫米杆未骨折，但矫正未丢失。所有患者各节段均实现了牢固融合。矢状面未受到器械的不利影响。然而，需要更多的患者数量和更长时间的随访。
