凸侧共平面矫形技术与凹侧平移技术对特发性胸椎侧凸的矫形效果比较

Comparison between vertebral coplanar alignment and traditional correction technique: a minimal 5-year follow-up research

中文关键词:  特发性脊柱侧凸  共平面矫形技术  胸椎侧凸  平移技术  内固定

英文关键词:Idiopathic scoliosis  Vertebral coplanar alignment  Ｔhoracic scoliosis  Spinal fusion  Internal fixation

中文摘要:

  【摘要】 目的：比较凸侧共平面（Coplanar）矫形技术与传统凹侧平移技术治疗特发性脊柱侧凸（idiopathic scoliosis，IS）胸弯患者的远期随访结果，评估凸侧Coplanar矫形技术在IS胸弯患者矫形中的临床疗效。方法：2008年6月~2012年9月分别应用凸侧Ｃoplanar技术（Coplanar组）和凹侧平移技术（传统组）行后路矫形术治疗IS胸弯患者94例。Coplanar组47例，其中女42例，男5例，年龄17.9±6.5岁，术前主弯Cobb角72.8°±14.8°，Risser征3.7±1.5，随访时间82.０±5.9个月。传统技术组47例，其中女43例，男4例，年龄16.1±5.7岁，术前主弯Cobb角75.4°±15.4°，Risser征3.5±1.3，随访时间76.０±7.2个月。记录两患者初诊、术后及末次随访时的主弯Cobb角、胸椎后凸角（TK），术前和术后时的椎体旋转角（ＲＡsac）、顶椎区椎体胸廓比（ＡＶＢ－Ｒ）、剃刀背（ＲＨ），以及手术时间、出血量和术后并发症等，并进行统计学分析。结果：两组患者的年龄、初始主弯Cobb角、Risser征、随访时间等均相匹配。两组手术时间、术中出血和术后并发症等均无显著性差异（P>0.05）。Coplanar组术后主弯Cobb角20.7°±8.9°，矫正率为7１.６%，末次随访矫正丢失率为6.6%；传统组术后主弯Cobb角为22.3°±7.8°，矫正率为70.4%，末次随访时矫正丢失率为5.2%，两组矫正率和矫正丢失率均无显著性差异（P>0.05）。Coplanar组术前ＲＡsac、ＡＶＢ－Ｒ、ＲＨ分别为３３．６°±１５．６°、１．８±０．５、４３.０±１５．８mm，术后分别为14.2°±16.2°、1.2±10.3、15.2±16.8mm；传统组术前分别为28.4°±14.9°、１．７±０．４、３９±１４．６mm，术后分别为１７．３°±６．９°、１．１±０．４、１８．３±７．２mm；两组术后ＲＡsac和ＲＨ有显著性差异（P<0.05）。Coplanar组术前、术后和末次随访时的TK分别15.8°±12.4°、27.4°±11.4°和25.8°±12.5°；传统组分别为17.8°±13.4°、20.2°±11.6°和9.3°±12.1°，两组术后和末次随访时均存在显著性差异（P<0.05）。结论：与传统凹侧平移技术相比，应用凸侧Colpanar矫形技术治疗ＩＳ主胸弯患者可获得与其相似的冠状面矫形，并能更好地去旋转和更好地重建矢状面平衡，长期随访结果满意。

英文摘要:

  【Abstract】 Objectives: To evaluate the long-term outcomes of posterior vertebral coplanar alignment(VCA) surgery when compared with traditional correction technique in idiopathic thoracic scoliosis. Methods: A total of 94 idiopathic scoliosis(IS) patients undergoing posterior correction surgery between June 2008 and September 2012 were included in this study. In the VCA group, there were 42 females and 5 males with an average age of 17.9±6.5 years. The average preoperative Cobb angle was 72.8°±14.8°,　the average Risser sign was 3.7±1.5 and the average time of follow-up was 82.0±5.9 months. In the traditional technique group, there were 43 females and 4 males with an average age of 16.1±5.7 years The average preoperative Cobb angle was 75.4°±15.4°, the average Risser sign was 3.5±1.3 and the average time of follow-up was 76.0±7.2 months. The two groups were matched in terms of age, Risser sign, Cobb angle and thoracic kyphosis(TK). Operation time, blood loss and surgery-related complications were recorded. Results: For the VCA group, the mean postoperative Cobb angle was 20.7°±8.9°　with a correction rate of 71.6%. The rate of correction loss was 6.6% at the final follow-up. For the traditional technique group, the mean postoperative Cobb angle was 22.3°±7.8°　with a correction rate of 70.4%. The rate of correction loss was 5.2% at the final follow-up. There was no difference of the correction rate and correction loss between two groups(Ｐ>0.05).　For the VCA group, the TK restored from 15.8°±12.4°　to 25.8°±12.5°　at the final follow-up. For the traditional group, the TK restored from 17.8°±13.4°　to 19.3°±12.1°　at the final follow-up. There was significant difference of TK between the two groups postoperatively and at the final follow-up(Ｐ<0.05). Besides, there was no difference of operation time, blood loss or post-operative complication between the two groups. Conclusions: Compared to traditional correction technique, the VCA technique can achieve similar correction outcomes in coronal plane,　but better derotation and correction outcomes in saggital plane.