摘要
目的探讨前路松解体内牵引技术治疗重度僵硬型脊柱侧凸的中期疗效。方法 2009年3月-2012年3月共26例重度僵硬型脊柱侧凸患者符合选择标准纳入研究,均经前路松解、后路生长棒体内撑开并二期后路固定融合治疗。男11例,女15例;年龄14～25岁,平均19.6岁。病程3～24年,平均13.6年。均为特发性脊柱侧凸,按Lenke分型：Ⅰ型2例、Ⅱ型8例、Ⅳ型13例、Ⅴ型1例、Ⅵ型2例。其中顶椎位于T6 1例、T7 3例、T8 7例、T9 13例、T10 2例。前路松解节段平均4个,14例患者行2次撑开,后路融合节段平均14个。分别测量术前、融合术后及末次随访时冠状面主弯Cobb角、顶椎偏移（apical vertebral translation,AVT）、冠状面平衡（C7 plumb line-center sacral vertical line,C7PL-CSVL）、矢状面平衡（sagittal vertical axis,SVA）、胸椎后凸角（thoracic kyphosis,TK）;采用简体中文版脊柱侧凸研究学会22项（SRS-22）量表评价患者的健康相关生存质量（health-related quality of life,HRQL）。结果总手术时间平均592.7 min,总出血量平均1 311.2 m L,住院费用（14.7±1.4）×104元,第1次撑开术后冠状面主弯Cobb角（55.7±16.5）°,第1次撑开术后TK（43.2±16.2）°。26例均获随访,随访时间2～5年,平均3.8年。1例出现撑开术后短暂呼吸困难症状,1例撑开术后出现胸腔积液,均经积极处理后症状消失;1例融合术后6个月出现融合末端螺钉松动及假关节形成,翻修后恢复良好。术后均无感染及神经系统并发症发生。所有患者融合术后及末次随访时的冠状面主弯Cobb角、TK和AVT均显著低于术前（P〈0.05）;以上指标融合术后与末次随访时比较差异无统计学意义（P〉0.05）。手术前后各时间点C7PL-CSVL和SVA比较,差异均无统计学意义（P〉0.05）。末次随访时,根据简体中文版SRS-22量表评分,其中功能/活动度（4.32±0.42）分、精神健康（4.54±0.58）分、自我形象/外观（3
Objective To observe the medium-term clinical and radiological outcomes of anterior release internal distraction in treatment of severe and rigid scoliosis. Methods Between March 2009 and March 2012, 26 patients with severe and rigid scoliosis were treated with anterior release, posterior internal distraction, and two stage posterior spinal fusion. There were 11 males and 15 females with an average age of 19.6 years（range, 14-25 years）. The average disease duration was 13.6 years（range, 3-24 years）. All cases were idiopathic scoliosis. Of 26 cases, 2 cases were rated as Lenke type I, 8 as type II, 13 as type IV, 1 as type V, and 2 as type VI. The apical vertebrae located at T6 in 1 case, at T7 in 3 cases, at T8 in 7 cases, at T9 in 13 cases, and at T10 in 2 cases. The average 4 vertebral bodies were released by anterior approach, and average 14 vertebral bodies were fused after posterior surgery. Fourteen patients received 2 times distraction. Scoliosis Research Society-22（SRS-22） questionnaire was used to access health-related quality of life. The radiological parameters were measured, including coronal plane Cobb angel of major curve, apical vertebral translation（AVT）, C7 plumb linecenter sacral vertical line（C7PL-CSVL）, sagittal vertical axis（SVA）, and thoracic kyphosis（TK） at pre- and post-operation. Results The average total operation time was 592.7 minutes; the average total blood loss volume was 1 311.2 m L; and total hospitalization cost was（14.7±1.4）×104 yuan RMB. The coronal plane Cobb angle of major curve was（55.7±16.5）°, and the TK was（43.2±16.2）° after first distraction. The patients were followed up 2-5 years（mean, 3.8 years）. Temporary dyspnea and pleural effusion occurred in 1 case respectively after distraction, and symptoms disappeared after symptomatic treatment. Screw loosening and pseudoarthrosis formation was observed in 1 case at 6 months after fusion, good recovery was achieved after revision. No infection or neurological complication was f
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2015年第9期1092-1098,共7页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
重度僵硬型脊柱侧凸
前路松解
体内牵引
后路融合
健康相关生存质量
Severe and rigid scoliosis Anterior release Internal distraction Posterior fusion Health-related quality of life
