Ghanem I B, Hagnere F, Dubousset J F, Watier B, Skalli W, Lavaste F
Division of Orthopaedic Surgery, Hotel-Dieu de France Hospital, Siant Joseph University, Beirut, Lebanon.
Spine (Phila Pa 1976). 1997 Aug 15;22(16):1913-21. doi: 10.1097/00007632-199708150-00021.
This study analyzed intraoperatively the three-dimensional displacement of vertebrae during rotation of the Cotrel-Dubousset rod for scoliosis correction, using an optoelectronic method.
To evaluate three-dimensional transitions and rotations of instrumented and uninstrumented vertebrae, produced by the Cotrel-Dubousset instrumentation "derotation" maneuver.
Published reports indicate that Cotrel-Dubousset instrumentation has been more effective in producing spinal derotation than vertebral axial derotation, but no study analyzed intraoperatively the effects on the vertebrae produced solely by rotation of the rod.
Eight patients with idiopathic scoliosis treated with Cotrel-Dubousset instrumentation underwent intraoperative optoelectronic monitoring using infrared cameras (Vicon). Markers were implanted in the spinous processes of the lower and upper instrumented vertebrae (LIV, UIV), the adjacent uninstrumented vertebrae below and above (-LIV, +UIV), and the apical vertebra. During rod rotation, acquisition and processing of cameras data were performed to obtain three-dimensional displacements of vertebrae.
Translations and rotations of LIV and UIV were in identical directions to those of -LIV and +UIV, respectively. Orientation of the LIV hook influenced the displacement of LIV and -LIV. Posterior translation of the apical vertebra was commonly observed in thoracic King II, III, or V curvatures (apical vertebra = T9), and anterior translation in King I and IV and thoracolumbar curvatures (apical vertebra = T11-T12). Axial rotation of the apical vertebra was increased in thoracic curvatures and decreased in thoracolumbar and lumbar curvatures. Lateral translation was the major displacement observed.
Rotation of the rod produces rotational and translational changes along each axis. These results are preliminary, but substantial. Technical improvement would allow more accurate results in the near future.
本研究采用光电方法，在术中分析Cotrel-Dubousset棒旋转时脊柱侧弯矫正过程中椎体的三维位移。
评估Cotrel-Dubousset器械“去旋转”操作所产生的植入器械椎体和未植入器械椎体的三维移位和旋转。
已发表的报告表明，Cotrel-Dubousset器械在产生脊柱去旋转方面比椎体轴向去旋转更有效，但尚无研究在术中分析仅由棒旋转对椎体产生的影响。
8例接受Cotrel-Dubousset器械治疗的特发性脊柱侧弯患者在术中使用红外摄像机（Vicon）进行光电监测。在植入器械的下、上椎体（LIV、UIV）、相邻的下方和上方未植入器械的椎体（-LIV、+UIV）以及顶椎的棘突上植入标记物。在棒旋转过程中，进行摄像机数据的采集和处理以获得椎体的三维位移。
LIV和UIV的平移和旋转分别与-LIV和+UIV的方向相同。LIV钩的方向影响LIV和-LIV的位移。在胸段King II、III或V型曲线（顶椎=T9）中，通常观察到顶椎向后平移，而在King I和IV型以及胸腰段曲线（顶椎=T11-T12）中则向前平移。顶椎的轴向旋转在胸段曲线中增加，在胸腰段和腰段曲线中减少。侧向平移是观察到的主要位移。
棒的旋转会沿每个轴产生旋转和平移变化。这些结果是初步的，但意义重大。技术改进将在不久的将来获得更准确的结果。
