双侧椎弓根交叉间隔置钉矫形治疗Lenke 1型青少年特发性脊柱侧凸

Department of Orthopedics，Changhai Hospital，Second Military University，Shanghai，200433，China

中文关键词:  青少年特发性脊柱侧凸  矫形手术  双侧间隔置钉  椎弓根

英文关键词:Adolescent idiopathic scoliosis  Corrective surgery  Bilateral interval pedicle screw fixation  Pedicle

中文摘要:

  【摘要】 目的：观察双侧椎弓根交叉间隔置钉矫形治疗Lenke 1型青少年特发性脊柱侧凸（AIS）的临床疗效。方法：2007年1月~2008年12月采用后路双侧椎弓根交叉间隔置钉矫形手术治疗Lenke 1型AIS患者36例，其中男7例，女29例，年龄11~18岁，平均15.3岁，术前胸椎侧凸角度均＜75°，且侧凸柔韧性均＞50%。测量术前和术后冠状面主胸弯Cobb角、胸椎矢状面Cobb角、C7铅垂线与骶骨正中线（CSVL）的距离、C7铅垂线与S1椎体后上角的垂直距离、双侧肋骨后凸的高度差（RH）、顶椎上下横突侧方5个肋间距总和的左右侧差值（ARSD）、胸弯顶椎椎体外侧缘至两侧胸壁距离的比值（AVB-R），分析临床疗效。结果：手术时间150~240min，平均176min；术中失血量460~1100ml，平均840ml。术中无脊髓、重要神经及血管损伤，1例患者术后出现左侧胸腔积液，2例患者术后2周出现伤口浅表感染。随访1.6~3.2年，平均2.06年。主胸弯冠状面Cobb角由术前56.7°±8.0°矫正为14.1°±6.0°（P<0.05），末次随访（17.2°±3.2°）与术后比较无显著性差异（P＞0.05）。胸椎矢状面Cobb角由术前的28.9°±7.9°减小为21.9°±10.6°（P<0.05），末次随访（24.3°±5.1°）与术后比较无显著性差异（P＞0.05）。矢状面C7铅垂线与S1椎体后上角的垂直距离由术前-11.7±12.1mm变为术后-1.4±9.4mm（P<0.05），末次随访（-2.7±4.7mm）与术后比较无显著性差异（P＞0.05）。RH、ARSD、AVB-R术前分别为37.7±5.8mm、20.1±6.6mm和1.56±0.16，术后分别为19.3±6.9mm、8.1±4.7mm和1.22±0.20，差异有显著性（P<0.05）。C7铅垂线与CSVL的距离术前、术后及末次随访无显著性差异（P＞0.05）。随访期间未发现内固定失败征象。结论：双侧椎弓根交叉间隔置钉矫形治疗柔韧性好的轻中度Lenke 1型AIS可以获得良好的三维矫形效果。

英文摘要:

  【Abstract】 Objective：To investigate the clinical efficacy of the bilateral interval pedicle screw placement for Lenke 1 adolescent idiopathic scoliosis（AIS）.Method：36 patients（7 males and 29 females） with Lenke 1 AIS（mean age，15.3 years） underwent posterior fusion using bilateral interval pedicle screw placement.All patients had preoperative coronal Cobb angle of main thoracic curve less than 75° and the flexibility greater than 50%.The following variables including pre-and post-operative sagittal and coronal Cobb angles，the distance between the C7 plumbline and the center sacral vertical line（CSVL），the distance between the C7 plumbline and the perpendicular line drawn from the superior posterior endplate of the S1 vertebral body[sagittal sacral vertical line（SSVL）]，rib hump（RH），apical rib spread difference（ARSD），apical vertebral body-rib ratio（AVB-R） were meassured and the clinical outcomes were analyzed.Result：The average operation time was 176min（range，150-240min），and the average blood loss was 840ml（range，460-1100ml）.No neurovascular injury was noted.1 case was complicated with left pleural effusion，and 2 cases were complicated with superficial wound infection 2 weeks after operation.Coronal Cobb angle of major curve decreased significantly from 56.7°±8.0° preoperatively to 14.1°±6.0° of postoperatively（P<0.05）.There was no significant difference between the postoperative thoracic curve and that at the final follow-up（Cobb angle 17.2°±3.2°，P>0.05）.The thoracic sagittal Cobb angle decreased significantly from 28.9°±7.9° preoperatively to 21.9°±10.6° postoperatively（P<0.05）.There was no significant difference between postoperative thoracic kyphosis and that at the final follow up（Cobb angle 24.3°±5.1°，P>0.05）.The distance from the C7 plumbline to the SSVL decreased from -11.7±12.1mm to -1.4±9.4mm（P<0.05）.There was no significant difference between postoperative distance and that at the final follow up（-2.7±4.7mm，P>0.05）.RH decreased from 37.7±5.8mm to 19.3±6.9mm（P<0.05），ARSD decreased from 20.1±6.6mm to 8.1±4.7mm（P<0.05），and AVB-R decreased from 1.56±0.16 to 1.22±0.20（P<0.05）.There were no differences between pre-，post-operation and final follow up with regard to the distance from C7 plumbline to the CSVL（P>0.05）.No instrument failure was noted during the follow up period.Conclusion：Bilateral interval pedicle screw placement can ensure good three-dimensional correction for mild to moderate Lenke 1 AIS.