Brook P D, Kennedy J D, Stern L M, Sutherland A D, Foster B K
Department of Orthopaedic Surgery, Women's and Children's Hospital, Adelaide, Australia.
J Pediatr Orthop. 1996 May-Jun;16(3):324-31. doi: 10.1097/00004694-199605000-00006.
The Women's and Children's Hospital experience with Luque spinal fusion in Duchenne's muscular dystrophy was reviewed from its commencement in 1983 to the present with a view to assessing the clinical and radiologic outcome and safety of the procedure. Seventeen boys have undergone spinal fusion. L-rod instrumentation was used in 10, six of whom had significant problems with sitting imbalance or progression of the scoliosis or both. In seven cases, distal instrumentation was taken to the pelvis with a Galveston construct and rigid crosslinking. Apart from some progression and sitting imbalance in the L-rod group, there were few complications. In the Galveston group, pelvic obliquity was corrected by a mean of 63%, and there was better maintenance of correction. There were no pseudoarthroses or instrument failures in the Galveston group. Of the total group, four patients had forced vital capacity (FVC) values < 25% predicted, and two required ventilation postoperative (< 48 h). There were no other respiratory complications. The effect of surgery on respiratory function remains uncertain. Spinal fusion with the Luque rod construct and pelvic fixation is a safe procedure. It provided a mean correction of 60% and control of pelvic obliquity without significant postoperative deterioration. In our experience, surgery can be safely performed with FVC value down to 20% predicted. On the basis of these data, one current practice is to instrument to the pelvis with a Galveston construct and Texas Scottish Rite Hospital cross-linking.
回顾了妇女儿童医院自1983年开始至今对杜氏肌营养不良症患者进行Luque脊柱融合术的经验，以评估该手术的临床、放射学结果及安全性。17名男孩接受了脊柱融合术。10例采用L棒器械固定，其中6例出现明显的坐姿失衡或脊柱侧凸进展或两者皆有。7例采用Galveston结构和坚固的交联装置将远端器械固定至骨盆。除L棒组有一些进展和坐姿失衡外，并发症较少。在Galveston组，骨盆倾斜平均矫正了63%，且矫正维持效果更好。Galveston组未出现假关节形成或器械故障。在整个组中，4例患者的用力肺活量（FVC）值<预测值的25%，2例术后（<48小时）需要通气。无其他呼吸并发症。手术对呼吸功能的影响仍不确定。采用Luque棒结构和骨盆固定的脊柱融合术是一种安全的手术。它平均矫正了60%，控制了骨盆倾斜，术后无明显恶化。根据我们的经验，FVC值低至预测值的20%时也可安全进行手术。基于这些数据，目前的一种做法是采用Galveston结构和德克萨斯州苏格兰礼仪医院的交联装置固定至骨盆。
