脊椎共面排列矫形技术治疗特发性脊柱侧凸的初步疗效

Preliminary outcome of three-dimensional correction for idiopathic scoliosis by vertebral coplanar alignment

中文关键词:  特发性脊柱侧凸  脊椎共面排列  去旋转  矢状面平衡

英文关键词:Idiopathic scoliosis  Vertebral coplanar alignment  Derotation  Sagittal alignment

中文摘要:

  【摘要】 目的：评估脊椎共面排列（vertebral coplanar alignment，VCA）矫形技术治疗特发性脊柱侧凸（idiopathic scoliosis，IS）的初步疗效。方法：2010年1月~9月采用VCA技术治疗IS患者20例，男5例，女15例，年龄11~21岁，平均15.3岁；Lenke 1型14例，2型6例；术前主弯Cobb角50°~86°，平均67.5°，柔韧性11.4%~50.9%，平均31.7%；胸椎后凸5°~55°，平均25.7°，按Lenke矢状面形态分，6例为“+”，4例为“-”，10例为“N”。均采用一期后路椎弓根螺钉固定、VCA矫形、同种异体骨植骨融合治疗。以主胸弯Cobb角评价矫正率，并测定胸椎后凸变化；以顶椎肋骨隆起间距（rib hump，RH）、顶椎椎体肋骨比（apical vertebral body rib ratio，AVB-R）、肋骨弥散间距（apical rib spread difference，ARSD）和椎体旋转角（rotational angle to sacrum，RAsac）评价旋转的矫正情况。结果：所有患者均成功完成矫形手术，手术时间115~196min，平均164min；术中出血400~800ml，平均680ml；未发生严重并发症。术后主弯Cobb角12°~27°，平均20.6°，平均矫正率70.1%；RH、AVB-R、ARSD及RAsac平均矫正率分别为56.3%、29.8%、74.3%和54.1%；术后后凸17°~27°，平均21.8°，术前为“+”或者“-”的患者均矫正为N，无1例发生或残留平背畸形。随访3~12个月，平均9个月，未见矫正丢失和失代偿发生。结论：VCA矫形技术能有效矫正IS患者的冠状面畸形，有效获得或维持胸椎生理性后凸，且具有较好的矫正旋转畸形的能力。

英文摘要:

  【Abstract】 Objective：To evaluate the preliminary outcome of vertebral coplanar alignment（VCA） for the management of idiopathic scoliosis（IS）.Method：20 patients with IS undergoing one-stage posterior pedicle screw fixation，VCA correction and allograft fusion were included in this study.There were 15 females and 5 males with the mean age of 15.3 years（range，11 to 21 years）.According to Lenke classification system，there were 14 type 1 and 6 type 2.The mean Cobb angle of the main curve was 67.5°（range，50° to 86°） and the mean thoracic kyphosis was 25.7°（range，5° to 55°）.After correction，the Cobb angle of the main curve and thoracic kyphosis were evaluated.The rib hump（RH），apical vertebral body rib ratio（AVB-R），apical rib spread difference（ARSD） and rotational angle to sacrum（RAsac） were measured to assess the correction of rotational deformity.Result：All patients underwent this surgical protocol successfully without major complications.The average operation time was 164min（range，115 to 196min），and the mean blood loss was 680ml（range，400 to 800ml）.The mean residual Cobb angle of main curve was 20.6°（range，12° to 27°） and the corrective rate was 70.1% with the corrective rate of RH，AVB-R，ARSD and RAsac of 56.3%，29.8%，74.3% and 54.1% respectively.The mean postoperative kyphosis was 21.8°（range，17° to 27°） and the thoracic kyphosis recovered to normal in all patients with no hypokyphosis noted.All patients were followed up for an average of 9 months（range，3 to 12 months）.No decompensation and loss of correction was noted.Conclusion：VCA correction can manage coronal misalignment， recover thoracic alignment and rotational deformity of IS effectively.