Bradford D S, Tribus C B
Department of Orthopaedic Surgery, University of California, San Francisco, USA.
Spine (Phila Pa 1976). 1997 Jul 15;22(14):1590-9. doi: 10.1097/00007632-199707150-00013.
A retrospective study of patients with rigid coronal decompensation.
To determine if patients with rigid coronal decompensation can be safely and successfully treated by anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion to correct their deformities.
Previous investigators have described reconstructive techniques used to treat patients with sagittal and coronal spine deformities. These techniques include osteotomy and anterior or posterior fusion. Although a number of these studies consider the problems associated with failed back syndrome (flatback, coronal and axial imbalance, pseudarthrosis), they have not satisfactorily addressed the management of rigid coronal decompensation. The patient population of the current study, on average, presented with more severe, fixed deformities than those detailed in the literature, and required more extensive surgery than previously described.
Twenty-four patients (average age, 27 years) with rigid coronal decompensation underwent anterior-posterior vertebral column resection, spinal shortening, posterior instrumentation, and fusion. Degree of curvature was measured in the coronal and sagittal planes, and decompensation was assessed. Follow-up was from 2 to 10 years.
Coronal and sagittal decompensation were corrected an average of 82% and 87%, respectively; T1 tilt and pelvic obliquity were improved by 65% and 53%, respectively; and scoliosis was improved by 52%. Complications occurred in 14 patients, but at follow-up all patients rated their results as either good or excellent.
Patients with fixed, decompensated spinal deformity may be safely corrected by vertebrectomy, decancellation, spinal shortening, instrumentation, and fusion. Complications are transient, and the benefits in this select group of patients outweigh the risks.
对僵硬性冠状面失代偿患者的回顾性研究。
确定僵硬性冠状面失代偿患者能否通过前后路脊柱切除术、脊柱缩短、后路内固定及融合术安全且成功地治疗以矫正其畸形。
既往研究者已描述了用于治疗矢状面和冠状面脊柱畸形患者的重建技术。这些技术包括截骨术及前路或后路融合术。尽管许多此类研究考虑了与失败的脊柱综合征（平背、冠状面和轴向失衡、假关节）相关的问题，但它们尚未令人满意地解决僵硬性冠状面失代偿的处理问题。与文献中详述的患者相比，本研究的患者群体平均存在更严重、固定的畸形，且需要比先前描述的更广泛的手术。
24例（平均年龄27岁）僵硬性冠状面失代偿患者接受了前后路脊柱切除术、脊柱缩短、后路内固定及融合术。测量冠状面和矢状面的弯曲度，并评估失代偿情况。随访时间为2至10年。
冠状面和矢状面失代偿分别平均矫正了82%和87%；T1倾斜度和骨盆倾斜度分别改善了65%和53%；脊柱侧弯改善了52%。14例患者出现并发症，但在随访时所有患者对其结果的评价均为良好或优秀。
固定性、失代偿性脊柱畸形患者可通过椎体切除术、去皮质术、脊柱缩短、内固定及融合术安全地矫正。并发症是暂时的，在这一特定患者群体中益处大于风险。
