CAJ | 학술논문

背景:既往文献报道马凡综合征患者脊柱侧凸的矫正有着较高的并发症和矫正率的丢失;运用脊柱三维矫形内固定系统治疗马凡综合征患者脊柱侧凸的报道较少.目的:观察CD、TSRH等第3代脊柱矫形内固定系统对马凡综合征患者脊柱侧凸的矫正效应.设计:回顾性分析.单位:合肥市第一人民医院骨二科.对象:于1997-09/2003-07选择资料完整的马凡综合征脊柱侧凸患者10例,行后路CD及TSRH器械矫形内固定,同时予以自体骨移植融合手术.双主弯型8例,胸椎侧弯2例,胸椎侧弯方向均为右侧弯.胸椎后凸3例,胸腰段后凸2例.方法:在术前、术后1周及随访时均拍摄站立位的正侧位X射线片.术前拍摄左右侧曲位及悬吊位X射线片,以评估侧凸的柔韧性.侧凸角度大小的测量方法采用Cobb法,同时记录侧凸的稳定椎及中立椎.10例患者均予以后路手术.2例使用CD系统矫形内固定,另外8例使用TSRH系统.植骨材料来源于自体髂后上棘.术后予以支具保护3个月.主要观察指标:术后脊柱侧凸的矫正率及并发症情况.结果:经过12～60个月的随访,8例双主弯型患者胸弯的矫正率为48%,随访矫正率丢失为20%;腰弯的矫正率为56%,随访矫正率丢失为16%;2例单胸弯型患者的矫正率为61%,随访矫正率丢失为8%.所有患者躯干平衡得到改善.无神经并发症的发生.2例出现交界性腰椎后凸.1例切口延迟愈合.结论:使用脊柱三维矫形内固定系统治疗马凡综合征患者脊柱侧凸,可以达到满意疗效.术前对马凡综合征患者的心肺情况进行评估,术中适当延长融合节段,避免过度矫正,减少软组织损伤,更加重视植骨融合是疗效满意的关键.
배경:기왕문헌보도마범종합정환자척주측철적교정유착교고적병발증화교정솔적주실;운용척주삼유교형내고정계통치료마범종합정환자척주측철적보도교소.목적:관찰CD、TSRH등제3대척주교형내고정계통대마범종합정환자척주측철적교정효응.설계:회고성분석.단위:합비시제일인민의원골이과.대상:우1997-09/2003-07선택자료완정적마범종합정척주측철환자10례,행후로CD급TSRH기계교형내고정,동시여이자체골이식융합수술.쌍주만형8례,흉추측만2례,흉추측만방향균위우측만.흉추후철3례,흉요단후철2례.방법:재술전、술후1주급수방시균박섭참립위적정측위X사선편.술전박섭좌우측곡위급현조위X사선편,이평고측철적유인성.측철각도대소적측량방법채용Cobb법,동시기록측철적은정추급중립추.10례환자균여이후로수술.2례사용CD계통교형내고정,령외8례사용TSRH계통.식골재료래원우자체가후상극.술후여이지구보호3개월.주요관찰지표:술후척주측철적교정솔급병발증정황.결과:경과12～60개월적수방,8례쌍주만형환자흉만적교정솔위48%,수방교정솔주실위20%;요만적교정솔위56%,수방교정솔주실위16%;2례단흉만형환자적교정솔위61%,수방교정솔주실위8%.소유환자구간평형득도개선.무신경병발증적발생.2례출현교계성요추후철.1례절구연지유합.결론:사용척주삼유교형내고정계통치료마범종합정환자척주측철,가이체도만의료효.술전대마범종합정환자적심폐정황진행평고,술중괄당연장융합절단,피면과도교정,감소연조직손상,경가중시식골융합시료효만의적관건.
BACKGROUND: Previous researches suggested that correction of scoliosis of patients with Marfan syndrome (MFS) has a high incidence of complication and loss of corrective rate; however, there were seldom reports on using spinal three-dimensional orthopaedic internal fixation system to treat scoliosis of MFS patients.OBJECTIVE: To observe the corrective effect of CD and TSRH, the third generation of spinal three-dimensional orthopaedic internal fixation system, on scoliosis of MFS patients.DESIGN: Retrospective analysis.SETTING: Second Department of Orthopaedics, First People's of Hefei.PARTICIPANTS: From September 1997 to July 2003, 10 MFS patients with scoliosis were selected and corrected at posterior site with CD and TSRH system; meanwhile, confluence operation of auto-bone transplantation was undergone.Eight cases had bilateral scoliosis, 2 curvature of thoracic spine towards right side, 3 posterior curvature of thoracic spine, and 2 posterior curvature of thoracic waist.METHODS: X-ray film was imaged at standing position before operation, 1 week after operation and during follow-up;meanwhile, X-ray film was also imaged at left and right curved positions and sling position to evaluate ductility of scoliosis before operation. Angle of scoliosis was measured with Cobb technique and stable and neutral mallets were recorded. Among 10 cases, 2 were internally fixed with CD system and other 8 with TSRH system. Material of bone transplantation was derived from auto-posterior superior iliac spine and remained for 3 months after operation.MAIN OUTCOME MEASURES: Corrective rate and complication of scoliosis after operation.RESULTS: The follow up lasted for 12-60 months. Corrective rate of 8 cases with bilateral scoliosis was 48% and lost rate was 20%; corrective rate of 2 cases with lumbar curvature was 56% and lost rate was 16%; corrective rate of 2 cases with single thoracic curvature was 61% and lost rate was 8%. Body balance of all patients was improved. No one had nerve complication; 2 had junctional posterior curvature of lumbar vertebra; 1 had delayed union of incisions.CONCLUSION: It is satisfactory for spinal three-dimensional orthopaedic intemal fixation system to treat scoliosis of MFS patients. Statuses of heart and lung of patients are evaluated before operation; in addition, during operation, a great effect is obtained through prolonging confluence segments, avoiding over correction, decreasing soft tissue injury and paying much attention on confluence of transplanted bone.