两种矫形方法治疗成人特发性脊柱侧凸的疗效比较

Comparison of the clinical outcome for adult idiopathic scoliosis treated by posterior spinal instrumentation with or without Halo-femoral traction after anterior release

中文关键词:  成人特发性脊柱侧凸  前路松解术  Halo－股骨髁上牵引  后路矫形术

英文关键词:Adult idiopathic scoliosis  Anterior spinal release  Halo-femoral traction  Posterior instrumentation

中文摘要:

  【摘要】 目的：比较单纯后路矫形术和一期前路松解、Halo－股骨髁上牵引加二期后路矫形术治疗成人特发性脊柱侧凸的疗效。方法：选取我院脊柱外科2003年1月~2007年12月收治的有完整影像学资料、Cobb角65°~90°的成人特发性脊柱侧凸患者30例，年龄20~30岁，平均23.4岁。均为初次手术，术前无神经损害。根据不同手术方法分为两组，行单纯后路矫形术的14例患者为A组，行一期前路松解、Halo－股骨髁上牵引及二期后路矫形术的16例患者为B组。两组患者术前侧凸Cobb角、胸椎后凸角、年龄、性别比、侧凸类型相匹配。随访时间为12～72个月，平均40个月。比较两组患者手术时间、出血量、住院时间、并发症情况、侧凸矫正率和冠状面平衡情况。结果：平均手术时间和平均住院时间A组分别为6.7±1.2h和24±18d，B组分别为9.9±1.4h和41±10d，B组均显著长于A组（P<0.05）。所有病例术后均无瘫痪、呼吸衰竭、死亡等并发症发生。术后侧凸矫正率A组为（51.3±11.8）％， B组为（64.5±11.6）％，B组显著大于A组（P<0.05）；胸椎后凸角、C7中垂线与骶骨中线的距离A组为20.6°±8.4°、1.32±0.65cm，B组为20.4°±6.7°、1.30±0.70cm，两组比较均无显著性差异（P>0.05）。末次随访时A组侧凸矫正丢失率为（3.5±2.4）%，B组为（2.8±1.5）%，两组无显著性差异（P>0.05）。结论：两种治疗方案治疗中度成人特发性脊柱侧凸均可获得较好的畸形矫正，一期前路松解、Halo－双侧股骨髁上牵引可以增加侧凸Cobb角矫正率，但是存在显著增加手术时间和住院时间等不足。

英文摘要:

  【Abstract】 Objectives： To compare the clinical outcome of posterior spinal instrumentation with or without Halo-femoral traction after anterior spinal release in the treatment of adult idiopathic scoliosis. Methods： 30 adult idiopathic scoliosis patients with Cobb angle range from 65°-90° treated from January 2003 to December 2007 were recruited into this retrospective study. The mean age of these patients was 23.4 years ranging 20-30 years. All patients received first operation without nerve injury before operation. Group A including 14 patients were treated by posterior instrumentation. Group B including 16 patients were treated by posterior instrumentation with Halo-femoral traction associated with anterior spinal release. The preoperative Cobb angle, age, sex ratio and curve pattern were similar in both groups. The mean follow-up was 40 months range from 12-72 months. Patients of two groups were compared with surgical time, blood loss, hospital stay time, complication, post-operative correction rate and coronal trunk balance. Results: The average surgical time (9.9±1.4h vs 6.7±1.2h) and length of hospital stay(41±10d vs 24±18d) in group B were much longer than that in group A(P<0.05). There was no complication occurred in the both groups at the final follow-up. The post-operative correction rate of group B was higher than that of group A［(64.5±11.6)％ vs (51.3±11.8)％, P<0.05]. Both groups achieved the similar postoperative thoracic sagittal alignment(20.6°±8.4° vs 20.4°±6.7°, P>0.05) and coronal trunk balance(1.32±0.65cm vs 1.30±0.70cm, P>0.05). There was no difference in terms of the loss of correction rate between the two groups at the final follow-up［(3.5±2.4)％ vs (2.8±1.5)％, P>0.05]. Conclusions: Halo-femoral traction associated with anterior spinal release is a safe and effective method to increase the correction rate in the moderate severe scoliosis patients with the Cobb angle ranging from 65 to 90 degrees, but may not be necessary because of the increased surgical time and hospital stay.