摘要
目的评价选择性前路胸腰段或腰段融合治疗PUMCⅡdl型（Lenke5型）青少年特发性脊柱侧凸（AIS）的临床效果。方法匝颐性分析35例行选择性前路胸腰段或腰段融合的PUMCⅡd1型（Lenke5型）AIS病例。所有病例均行前路单棒节段性固定融合，随访18—42个月，平均36个月。术前、术后及随访时均摄站立位全脊柱正侧位x线片，对躯干偏移、上下融合椎邻近椎间盘开角、下固定椎的倾斜、冠状面和矢状面Cobb角进行测量分析。测量数据使用SPSS11．0统计学软件进行分析。结果胸腰弯或腰弯冠状面Cobb角术前平均45．6°，术后9．7°，末次随访14．4°。胸弯冠状面Cobb角术前平均29．7°，术后17．6°，末次随访20．1°。躯干偏移术前平均14．0mm，术后14．8mm，末次随访5．1mm。下端固定椎（LIV）倾斜术前平均-21．8°，术后-1．5°，末次随访-2．1°。冠状面上端固定椎（UIV）上位椎间盘开角（UIVDA）及LIV下位椎间盘开角（LIVDA）术前分别为0．5°和0．6°，术后为0．9°和4．9°，末次随访时均显著加重，为3．0°和7．8°。矢状面胸段（T5-12）及胸腰段（T10-L2）曲度术后及末次随访时均保持良好。矢状面腰前凸（L1～S1）及固定融合节段Cobb角在术后有所减小，末次随访时均保持良好。所有病例末次随访时均未见假关节形成及其他并发症。结论选择性前路胸腰段或腰段融合是治疗PUMCⅡdl型（Lenke5型）AIS的安全、有效的方法，融合节段上、下椎间盘开角增加及部分病例残余胸弯过大现象需进一步随访评估。
Objective To evaluate the outcomes of selective anterior thoracolumbar or lumbar （TL/L） fusion for adolescent idiopathic scoliosis （AIS） with PUMC Ⅱ dl curves （ Lenke type 5 ）. Methods Thirty-five consecutive AIS patients （ PUMC type Ⅱ dl, Lenke type 5 ） with selective anterior TL/L fusion with single solid rod instrumentation were reviewed. The average follow-up was 36 months （range, 18-42 months）. Standing anterioposterior and lateral radiographs were measured and analyzed. Results The average preoperative Cobb angle of the TL/L curves was 45.6° and corrected to 9.7° postoperatively, with 79.7% curve correction. The thoracic curves decreased from 29. 7° preoperatively to 17. 6° postoperatively, with a spontaneous correction of 41.5%. There was an average 4. 7°and 2. 5° correction loss of the TL/L and the thoracic curves at the final follow-up respectively. Trunk shift deteriorated slightly from 14. 0 mm preoperatively to 14. 8 mm postoperatively, and improved significantly to 5.1 mm at the final follow-up. The lowest instrumented vertebra （LIV） tilt was significantly improved after surgery （from -21.8° preoperatively to - 1.5° postoperatively） and well maintained at the final follow-up （ - 2. 1°）. The coronal disc angle immediately above the upper instrumented vertebra （ UIVDA ） and below the LIV （ LIVDA ） averaged 0. 5° and 0. 6° respectively, and aggravated after surgery （0.9° and 4. 9°, respectively）. Both the UIVDA and LIVDA were significantly aggravated at the final follow-up （3.0° and 7.8°, respectively）. The sagittal contours of T5-12 and T10-L2 were well maintained after surgery and at the final follow-up. The lumbar lordosis of L1 -S1 and the sagittal Cobb angle of the instrumented segments were reduced postoperatively and at the final follow-up. No pseudarthrosis or other complications were observed. Conclusion Selective anterior TL/L fusion with single solid rod instrumentation is effective and safe for AIS with PUMC Ⅱ dl （Lenke t
出处
《中华外科杂志》
CAS
CSCD
北大核心
2009年第10期758-761,共4页
Chinese Journal of Surgery
