Hopf C G, Eysel P, Dubousset J
Department of Orthopaedic Surgery, Johannes Gutenberg University, Mainz, Germany.
Spine (Phila Pa 1976). 1997 Mar 15;22(6):618-27; discussion 627-8. doi: 10.1097/00007632-199703150-00008.
This study analyzes the effects of a new anterior spinal instrumentation system and the results of use in 50 patients with scoliosis.
Anterior spine systems are reviewed. The principles of a new anterior spinal instrumentation system allowing for postoperative care without external support are discussed.
Numerous different implants have been presented in the literature for anterior spinal surgery. Nevertheless a primary stable anterior instrumentation was not available for multisegmental procedures until now, and the restoration of lordosis in the lumbar spine was very difficult with the common devices. The development of more stable devices that also allow a restoration of lordosis in combination with derotation and compression is discussed.
Fifty patients with scoliosis of different etiologies (neuromuscular: n = 33; idiopathic: n = 16; congenital: n = 1) underwent anterior spinal surgery at the thoracic, thoracolumbar, and lumbar spine. During follow-up, no revision operation was necessary after the monosegmental and multisegmental application of this method, and there were no vessel complications. The results were controlled with a mean follow-up of 26.6 (range 12-41) months.
Clinical and radiologic follow-up and complications are reported. Statistical data obtained show a different average blood loss and operation time depending on the different etiology of the scoliotic deformity. The mean corrections for the scolioses by etiology are as follows: myelomeningocele (MMC) (mean preoperative angle 89 degrees, mean correction 54%); neuromuscular (81 degrees, 46%); and idiopathic (55 degrees, 69%). The mean lordosis of the lumbar spine was 29.2 degrees (measured between T12-S1) and could be corrected to 45.2 degrees depending on the etiology of the curvature, whereas the angle of the thoracic kyphosis did not show an essential change. The segmental measurement in idiopathic scoliosis did not show a kyphosization in the lumbar spine. Derotation of the apical vertebra in 15 patients in relation to the sagittal plane was 37%.
The study shows the effect of a new anterior device allowing the application of three-dimensional correction forces to the spine. Particularly in scoliosis derotation, compression and restoration of lordosis are possible. Primary stability is obtained by anchoring the implants with a new wedge-locking technique, which makes postoperative external support unnecessary.
本研究分析了一种新型前路脊柱内固定系统的效果以及其在50例脊柱侧弯患者中的使用结果。
对前路脊柱系统进行综述。讨论一种新型前路脊柱内固定系统的原理，该系统允许在无需外部支撑的情况下进行术后护理。
文献中已介绍了许多用于前路脊柱手术的不同植入物。然而，直到现在，对于多节段手术还没有一种主要稳定的前路内固定装置，而且使用普通装置很难恢复腰椎前凸。本文讨论了开发更稳定的装置，这些装置还能结合去旋转和压缩来恢复前凸。
50例不同病因的脊柱侧弯患者（神经肌肉型：n = 33；特发性：n = 16；先天性：n = 1）在胸段、胸腰段和腰段接受了前路脊柱手术。在随访期间，单节段和多节段应用该方法后无需翻修手术，且无血管并发症。平均随访26.6个月（范围12 - 41个月），对结果进行了对照分析。
报告了临床和影像学随访情况及并发症。所获得的统计数据显示，根据脊柱侧弯畸形的不同病因，平均失血量和手术时间有所不同。按病因分类，脊柱侧弯的平均矫正情况如下：脊髓脊膜膨出（MMC）（术前平均角度89度，平均矫正54%）；神经肌肉型（81度，46%）；特发性（55度，69%）。腰椎的平均前凸为29.2度（在T12 - S1之间测量），根据弯曲病因可矫正至45.2度，而胸段后凸角度没有显著变化。特发性脊柱侧弯的节段测量显示腰椎没有后凸形成。15例患者顶椎相对于矢状面的去旋转角度为37%。
该研究显示了一种新型前路装置的效果，该装置能够对脊柱施加三维矫正力。特别是在脊柱侧弯的去旋转、压缩和前凸恢复方面是可行的。通过一种新的楔形锁定技术固定植入物可获得初始稳定性，这使得术后无需外部支撑。
