CAJ | 학술논문

目的评价生长阀双棒内固定技术治疗早发的儿童脊柱侧凸的初步应用结果 .方法 2004年11月至2009年3月行生长阀双棒内固定技术治疗儿童脊柱侧凸11例,男1例,女10例;年龄2.1～10.9岁,平均6.1岁.Risser征均为0级.胸椎侧凸8例,胸腰椎侧凸3例;先天性脊柱侧凸10例,神经肌肉性脊柱侧凸1例.10例采用Isola生长阀固定,1例采用TSRH生长阀固定.撑开1～4次,平均1.8次.随访4.2～38.1个月,平均17.3个月.结果术前主弯Cobb角67.64°±11.43°,胸后凸31.00°±22.40°,躯干偏移(2.00±1.73)cm,T1S1高度(25.47±6.16)cm;初次术后主弯Cobb角34.64°±8.26°,胸后凸23.00°±8.06°,躯干偏移(1.49±1.31)cm,T_1～S_1高度(28.84±5.69)cm;末次术后主弯Cobb角36.82°±11.76°,胸后凸27.18°±8.97°,躯干偏移(1.11±1.29)cm,T_1～S_1高度(31.29±4.50)cm.术前、初次术后和末次术后主弯侧凸角比较差异有统计学意义.初次手术矫止率47.15%±16.48%,T_1～S_1高度增加(3.37±1.62)cm;末次手术矫正率44.73%±19.43%,T_1～S_1高度增加(5.82±2.21)cm.治疗期间T_1～S_1每年平均生长1.6 cm(1.1～2.7 cm).5例出现并发症:3例脱钩,1例椎弓根螺钉脱出,1例断棒.结论生长阀双棒内固定技术允许脊柱纵向生长,同时起到矫形和控制畸形发展的作用,但术后并发症发生率较高.
목적 평개생장벌쌍봉내고정기술치료조발적인동척주측철적초보응용결과 .방법 2004년11월지2009년3월행생장벌쌍봉내고정기술치료인동척주측철11례,남1례,녀10례;년령2.1～10.9세,평균6.1세.Risser정균위0급.흉추측철8례,흉요추측철3례;선천성척주측철10례,신경기육성척주측철1례.10례채용Isola생장벌고정,1례채용TSRH생장벌고정.탱개1～4차,평균1.8차.수방4.2～38.1개월,평균17.3개월.결과 술전주만Cobb각67.64°±11.43°,흉후철31.00°±22.40°,구간편이(2.00±1.73)cm,T1S1고도(25.47±6.16)cm;초차술후주만Cobb각34.64°±8.26°,흉후철23.00°±8.06°,구간편이(1.49±1.31)cm,T_1～S_1고도(28.84±5.69)cm;말차술후주만Cobb각36.82°±11.76°,흉후철27.18°±8.97°,구간편이(1.11±1.29)cm,T_1～S_1고도(31.29±4.50)cm.술전、초차술후화말차술후주만측철각비교차이유통계학의의.초차수술교지솔47.15%±16.48%,T_1～S_1고도증가(3.37±1.62)cm;말차수술교정솔44.73%±19.43%,T_1～S_1고도증가(5.82±2.21)cm.치료기간T_1～S_1매년평균생장1.6 cm(1.1～2.7 cm).5례출현병발증:3례탈구,1례추궁근라정탈출,1례단봉.결론 생장벌쌍봉내고정기술윤허척주종향생장,동시기도교형화공제기형발전적작용,단술후병발증발생솔교고.
Objective To determine the primary effect of the dual growing rod technique on treat-ment of rapidly progressing scoliosis in young children. Methods Eleven children treated with dual growing rod technique because of rapidly progressing seoliosis between November 2004 and March 2009 were ana-lyzed. Instrumentation of Isola was used in 10 cases and TSRH Domino in 1. The mean age at initial surgery was 6.1 years. There were 10 females and 1 male in the group with Risser sign of 0 grade. Their diagnoses included 10 patients with congenital scoliosis and 1 with neuromuscular seolinsis. All the patients had 1-4 lengthening procedures. Results The coronal Cobb angle improved from 67.64°±11.43° to 34.640°±8.26° after initial surgery with the correction rate observed at 47.15%±16.48%. The coronal trunk shift improved from (2.00±1.73) cm to (1.49±1.31) cm after initial surgery. The T_1-S_1 height increased from (25.47±6.16) cm to (28.84±5.69) cm after initial surgery. The coronal Cobb angle was 36.82°±11.76° and the coronal trunk shift was (1.11±1.29) cm after the most recent lengthening procedure with the most recent correction rate ob-served at 44.73%±19.43%. The T_1-S_1 height was (31.29±4.50) cm after the most recent lengthening proce-dure with an average T_1-S_1 length increase of 1.6 cm per year during the lengthening period. Five of the total patients had complications including: hook displacement, pedical screw loosening, and broken rod. The coronal Cobb angle between pre-operative, initial surgery and the most recent lengthening procedure were significantly different. Conclusion The dual growing rod technique was useful in the management of rapidly progressing scoliosis in young children. This technique offers control of severe scoliosis, allows for spinal growth, and maintains the coronal and sagittal balance, but has high complications.