Stella G, Ascani E, Cervellati S, Bettini N, Scarsi M, Vicini M, Magillo P, Carbone M
Second Department of Orthopedic Surgery, Istituto G. Gaslini, Genoa, Italy.
Eur J Pediatr Surg. 1998 Dec;8 Suppl 1:22-5. doi: 10.1055/s-2008-1071247.
Twenty-nine patients (mean age 12 years) with severe thoracolumbar and lumbar scoliosis due to myelomeningocele were treated by spinal fusion (7 by posterior arthrodesis with instrumentation, 3 by anterior arthrodesis with instrumentation, 19 by combined anterior and posterior fusion with instrumentation). Fusion was extended to the sacrum in 15 patients. Mean period of follow-up was 6.2 years. The average Cobb angle changes were as follows: thoracic and thoracolumbar curves preoperatively 86 degrees to 45 degrees at follow-up (the final average curve correction was 47%); lumbar curves preoperatively 97 degrees to 48 degrees at follow-up (the final average curve correction was 50%). Average pelvis obliquity changed from 26 degrees to 13 degrees at follow-up with an average correction of 49%. The combined anterior and posterior instrumentation and fusion gave the best correction of deformity (the final average thoracic and thoracolumbar curve correction was 55%; the final average lumbar curve correction was 61%). Independent of the method of stabilization, post-operative wound infection was a serious problem (24%). The combined fusion-instrumentation method reduced the rate of pseudoarthrosis to 14%.
29例（平均年龄12岁）因脊髓脊膜膨出导致严重胸腰段和腰段脊柱侧弯的患者接受了脊柱融合术（7例行后路融合内固定术，3例行前路融合内固定术，19例行前后路联合融合内固定术）。15例患者的融合范围延伸至骶骨。平均随访时间为6.2年。平均Cobb角变化如下：胸段和胸腰段曲线术前为86度，随访时为45度（最终平均曲线矫正率为47%）；腰段曲线术前为97度，随访时为48度（最终平均曲线矫正率为50%）。平均骨盆倾斜度随访时从26度变为13度，平均矫正率为49%。前后路联合内固定融合术对畸形的矫正效果最佳（最终胸段和胸腰段曲线平均矫正率为55%；最终腰段曲线平均矫正率为61%）。无论采用何种稳定方法，术后伤口感染都是一个严重问题（发生率为24%）。联合融合内固定术使假关节形成率降至1 / 4。
