摘要
目的探讨后路矫形侧间隔置钉、支撑侧每隔1或2个节段置钉治疗Lenke 5型青少年特发性脊柱侧凸(AIS)的疗效。方法回顾性分析2001年6月—2012年12月本院收治的20例Lenke 5型AIS患者的影像学资料。术前、术后1周及末次随访时测量胸椎及腰椎Cobb角、冠状面平衡、矢状面平衡、双肩高度差、顶椎偏移(AVT),近端固定椎(UIV)及远端固定椎(LIV)倾斜角、LIV下终板与其下位椎体上终板间的夹角(∠α)、颈椎前凸角、胸椎后凸角及腰椎前凸角。计算术前胸椎和腰椎侧凸的柔韧度、术后Cobb角的矫正率及双侧平均置钉密度。结果所有手术顺利完成。所有患者随访3.6~12.6年,平均7.3年。术前胸椎及腰椎平均柔韧度分别为74%和67%。平均固定节段7.6个,平均置钉密度矫形侧为59%、支撑侧为43%。术后1周及末次随访时腰椎和胸椎Cobb角、UIV和LIV倾斜角及腰椎AVT较术前明显减小,差异均有统计学意义(P<0.05)。结论后路矫形侧间隔置钉、支撑侧每隔1或2个节段置钉治疗柔韧度较高的Lenke 5型AIS可获得满意的矢状面及冠状面矫形效果,该方法明显减少了置钉数量、手术时间和术中创伤,同时减轻了患者的经济负担。
Objective To investigate the clinical efficacy of posterior interval pedicle screw fixation in correction side and 1 or 2 segments interval fixation in supporting side for treatment of Lenke 5 adolescent idiopathic scoliosis(AIS).Methods From June 2001 to December 2012,the imaging data of 20 Lenke 5 AIS patients who received posterior deformity correction surgeries were retrospectively analyzed.The thoracic and lumbar Cobb's angles,coronal transverse axis,sagittal vertical axis,height difference between shoulders,apical vertebral translation(AVT),upper and lower instrumented vertebral(UIV and LIV)tilt,the angle between the lower endplate of LIV and the upper endplate of the lower vertebral body(∠α),cervical lordosis,thoracic kyphosis and lumbar lordosis were measured and compared at pre-operation,postoperative 1 week and the final follow-up.The flexibility of thoracic and lumbar scoliosis,the correction rate of thoracic and lumbar Cobb's angles and implant density were calculated.Results All the operations were successfully completed.All the patients were followed up for 3.6-12.6 years,with an average of 7.3 years.The preoperative thoracic and lumbar flexibility were 74%and 67%respectively.The mean fusion segments were 7.6,the mean screw density was 59%in correction side and 43%in supporting side.Thoracic and lumbar Cobb's angles,UIV and LIV tilt,lumbar AVT were decreased significantly at postoperative 1 week and the final follow-up,and the differences were statistically significant(P<0.05).Conclusions Posterior interval vertebral pedicle screw fixation in correction side and 1 or 2 segments interval fixation in supporting side can obtain satisfactory results in sagittal and coronal plane for Lenke 5 AIS patients with good flexibility.This method can significantly reduce the number of screws,operation time and intraoperative trauma,and decrease the economic burden of patients.
作者
郑光彬
王章富
洪正华
Zheng Guangbin;Wang Zhangfu;Hong Zhenghua(Department of Orthopaedics,Taizhou Hospital,Wenzhou Medical University,Linhai 317000,Zhejiang,China)
出处
《脊柱外科杂志》
2021年第3期156-160,共5页
Journal of Spinal Surgery
关键词
青少年
胸椎
腰椎
脊柱侧凸
脊柱融合术
内固定器
Adolescent
Thoracic vertebrae
Lumbar vertebrae
Scoliosis
Spinal fusion
Internal fixators
