摘要
背景:通常重度青少年特发性胸椎侧凸患者骨骼比较僵硬,为增加侧凸的矫正率和融合率,目前国内外常规治疗方案为前路松解加后路矫形。但无论是前路开胸或胸腔镜操作均会产生较高的并发症。目的:对比观察前后路联合矫形和单纯后路矫形治疗重度青少年特发性胸椎侧凸患者的效果。设计、时间及地点:回顾性病例分析,病例来自1998-06/2005-06解放军第二军医大学长海医院骨科。对象:选择解放军第二军医大学长海医院骨科收治的行脊柱侧凸矫形融合术的青少年重度特发性胸椎侧凸患者126例,男27例,女99例,年龄10～18岁。方法:根据矫形方式将126例患者分为2组:前后路联合组(n=32):采用前路松解加后钉钩混合系统矫形;单纯后路组(n=94):单纯行后路手术,其中单纯后路组中18例单纯运用钩系统,22例运用钉钩混合系统,54例单纯运用全胸椎弓根螺钉系统。平均随访3.5年。临床采用影像学指标和SRS随访表格评估,统计学数据分析采用Wilcoxon-Mann-Whitney及Kruskal-Wallis检验。主要观察指标:胸椎侧凸度数,胸弯侧曲位度数,T5～12后凸角。结果:前后路联合组和单纯后路组两组患者在性别、年龄、融合节段、手术前Cobb角、柔韧性、矢状位胸椎后凸角度方面差异均无显著性意义。但前后路联合手术对冠状面Cobb角矫正率更高(P=0.0075),矢状面T5～12后凸矫形丢失率和SRS随访评分均无明显差异。单纯后路全椎弓根螺钉系统冠状面矫正率优于单纯后路钩系统与单纯后路钉钩混合系统两组(P=0.0120);而与前后路联合组相比,差异无显著性意义(P=0.9524)。所有患者均未因置入物失败或假关节形成而再次手术。结论:对于重度青少年特发性胸椎侧凸,运用钉、钩混合系统前后路联合矫形比单纯后路钩系统及钉钩混合系统矫形更为有效,但采用单纯后路全胸椎弓根螺钉系统则可以达到与前后路联
BACKGROUND： Generally, the skeleton is very stiff in patients with severe Lenke type 1 adolescent idiopathic scoliosis （AIS）. Traditional surgical treatment consists of anterior release and posterior fusion to improve the coronal correction and fusion rate. Unfortunately, they are always followed by relatively high incidence of complications. OBJECTIVE： To compare the clinical outcomes of anterior-posterior spinal fusion （APSF） versus posterior spinal fusion （PSF） alone for patients with severe （Cobb angle between 75° and 100°） Lenke type 1 AIS. DESIGN, TIME AND SETTING： Retrospective case analysis. The patients were selected from Department of Orthopedics, Changhai Hospital of Second Military Medical University of Chinese PLA between June 1998 and June 2005. PARTICIPANTS： 126 patients with severe Lenke type 1 AIS, who underwent spinal fusion （APSF or PSF） at Department of Orthopedics, Changhai Hospital of Second Military Medical University of Chinese PLA were included for analysis, including 99 females and 27 males, aged 10-18 years. METHODS： All patients were divided into 2 groups. In APSF group （n=32）, anterior release and posterior hooks were used; in PSF group （n=94）, posterior approach operation alone was performed, of which, 18 cases underwent hook alone, 22 underwent hybrid constructs of proximal hooks and distal pedicle screws, and 54 underwent pedicle screw alone. The patients were followed up for average of 3.5 years. Imaging measures and SRS follow-up form were used to evaluate results. The primary and secondary statistical analyses were analyzed using Wilcoxon-Mann-Whitney tests and the KruskaI-Wallis test. MAIN OUTCOME MEASURES： Lateral curve angle, lateral bending angle and T5-12 posterior convex angle. RESULTS： There were no statistically significant differences between two groups in terms of gender, age, number of levels fused, Cobb angle measurement of preoperative coronal or sagittal thoracic curve magnitude. The APSF group, when compared with the PSF
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2009年第26期5056-5061,共6页
Journal of Clinical Rehabilitative Tissue Engineering Research
