Willers U, Transfeldt E E, Hedlund R
Department of Orthopedic Surgery, Huddinge University Hospital, Sweden.
Eur Spine J. 1996;5(6):387-93. doi: 10.1007/BF00301966.
The segmental effect of Cotrel-Dubousset instrumentation (CDI) on the spine and thoracic cage was investigated in 38 patients with adolescent idiopathic scoliosis by preoperative and postoperative postero-anterior and lateral radiographs and computed tomography from T1 to S1. Mean Cobb angle decreased by 67%. The T5-T12 kyphosis in the hypokyphotic patients increased on average by 8.4 degrees (P < 0.001). Average preoperative as well as postoperative maximal vertebral rotation was located at the apex level, and was reduced from 19.0 degrees to 14.3 degrees (P < 0.001). All vertebrae between the upper and lower instrumented vertebrae were significantly derotated. Average derotation for the apical zone was 4.8 degrees (P < 0.001), for the upper instrumented zone it was 2.5 degrees (P < 0.01), and for the lower instrumented zone it was 2.6 degrees (P < 0.01). Vertebral derotation was significantly higher in the apical zone than in the upper and lower instrumented zones. The apical rib hump index (RHi) decreased by 38% (P < 0.001) and the cumulative RHi for the five apical levels decreased by 34% (P < 0.001). The RHi for the two levels above and below the instrumentation each decreased by 20% (n.s.). No significant increase in sagittal or transverse rib cage diameter at any level was observed. The translation in the coronal plane of the apical vertebra of major right thoracic curves improved significantly (P < 0.001). The preoperative flexibility index of the major curve correlated positively (r = 0.47) with derotation at the apex level (P < 0.01). However, no correlation was found between flexibility index and reduction of RHi at the apex level. Vertebral derotation did not correlate with reduction in RHi at any level. The study shows that CDI results in a postoperative three-dimensional improvement of the spine and a limited improvement of the thoracic cage, with no tendency towards a worsened deformity at any level within or outside the instrumentation.
通过术前及术后从T1至S1的正位和侧位X线片以及计算机断层扫描，对38例青少年特发性脊柱侧凸患者研究了Cotrel-Dubousset器械（CDI）对脊柱和胸廓的节段性影响。平均Cobb角减小了67%。后凸不足患者的T5-T12后凸平均增加了8.4度（P<0.001）。术前及术后最大椎体旋转平均位于顶椎水平，从19.0度降至14.3度（P<0.001）。上下固定椎体之间的所有椎体均有显著的去旋转。顶椎区平均去旋转4.8度（P<0.001），上固定区为2.5度（P<0.01），下固定区为2.6度（P<0.01）。椎体去旋转在顶椎区显著高于上、下固定区。顶椎肋骨隆起指数（RHi）降低了38%（P<0.001），五个顶椎水平的累积RHi降低了34%（P<0.001）。器械上下两个水平的RHi各降低了20%（无统计学意义）。在任何水平均未观察到矢状面或横断面胸廓直径有显著增加。主要右胸弯顶椎在冠状面的平移有显著改善（P<0.001）。主弯术前柔韧性指数与顶椎水平去旋转呈正相关（r = 0.47）（P<0.01）。然而，柔韧性指数与顶椎水平RHi降低之间未发现相关性。椎体去旋转在任何水平与RHi降低均无相关性。该研究表明，CDI可使脊柱在术后获得三维改善，胸廓有有限改善，且在器械内或器械外的任何水平均无畸形加重的趋势。
