CAJ | 학술논문

目的探讨胸弯型青少年特发性脊柱侧凸患者行后路选择性胸椎融合术时采用不同内固定方式对胸椎矢状面形态及远端腰椎代偿模式的影响.方法行胸弯后路矫形内同定术且有2年以上(2～3年)完整随访资料的lenke 1、2型青少年特发性脊柱侧凸患者51例,按内固定方式分为A组(全钩组)、B组(钩钉混合组)和C组(全钉组).测量术前及术后随访的胸弯Cobb角、腰弯Cobb角、胸椎后凸角、腰椎前凸角、远端交界性后凸、胸腰段交界性后凸及C7铅垂线偏离S1后上缘的距离.结果三组患者主弯矫正率均大于60%,继发弯也获得较满意的自发性矫正.三组患者术前及随访中腰椎前凸角、C7铅垂线偏离S1后上缘的距离均保持正常.随访2年时,A组远端交界性后凸、胸椎后凸角、胸腰段交界性后凸分别达3.6°、23.0°、6.4°,其中远端交界性后凸与术前比较差异有统计学意义(P<0.05).B组和C组各项指标与术前比较差异均无统计学意义.结论全钩型同定可以获得良好的冠状面矫形,且在随访中能保持腰椎前凸和欠状面平衡.但钩的固定不如椎弓根螺钉牢固,全钩型固定患者胸椎后凸角有增大趋势,胸腰椎交界区有失代偿的可能.
목적 탐토흉만형청소년특발성척주측철환자행후로선택성흉추융합술시채용불동내고정방식대흉추시상면형태급원단요추대상모식적영향.방법 행흉만후로교형내동정술차유2년이상(2～3년)완정수방자료적lenke 1、2형청소년특발성척주측철환자51례,안내고정방식분위A조(전구조)、B조(구정혼합조)화C조(전정조).측량술전급술후수방적흉만Cobb각、요만Cobb각、흉추후철각、요추전철각、원단교계성후철、흉요단교계성후철급C7연수선편리S1후상연적거리.결과 삼조환자주만교정솔균대우60%,계발만야획득교만의적자발성교정.삼조환자술전급수방중요추전철각、C7연수선편리S1후상연적거리균보지정상.수방2년시,A조원단교계성후철、흉추후철각、흉요단교계성후철분별체3.6°、23.0°、6.4°,기중원단교계성후철여술전비교차이유통계학의의(P<0.05).B조화C조각항지표여술전비교차이균무통계학의의.결론 전구형동정가이획득량호적관상면교형,차재수방중능보지요추전철화흠상면평형.단구적고정불여추궁근라정뢰고,전구형고정환자흉추후철각유증대추세,흉요추교계구유실대상적가능.
Objective To explore the effect of various instrumentation patterns on the sagittal re-construction with selective posterior fusion for thoracic adolescent idiopathic scoliosis (A1S). Methods Fifty-one AIS patients of Lenke 1A, IB, 1C and 2B who underwent selective posterior thoracic fusion in at least 24 months follow-up were evaluated. The patients were divided into three groups: Group A (all-hook system), Group B (hybrid system with upper thoracic hooks and lower pedicle screws), and Group C (all-screw sys-tem). The radiological parameters before and after surgery included thoracic and lumbar curve Cobb angle, thoracic kyphosis(TK), lumbar lordosis (LL), thoracolumbar junction kyphosis (T10-I2, TJK), distal junctional kyphosis (DJK), and sagittal vertical axis (SVA). Results Over 60% coronal correction of the primary curve and a satisfactory spontaneous correction of the secondary curve were achieved in three groups. There was no change of LL in three groups and SVA maintained in normal range before surgery and during follow-up peri-ods in all groups. However, in Group A, at the last phase of this research, DJK had a mean value of 3.6° of kyphosis compared with preoperative angle of -2.3° (P=0.037), which showed a lordosis loss of 5.9° in Group A. TK averaged 23.0° at the last phase compared with preoperative angle of 13.5° (P=0.072). TJK averaged 6.4° at the last phase compared with preoperative angle of -2.8° (P=0.070), and there was a lordosis loss of 9.2°. There were no obvious changes of TK, TJK and DJK in Group B and Group C during the whole follow-up. Conclusion Satisfactory correction on coronal plane, sagittal balance and lumbar lordosis could be maintained with selective thoracic all-hook instrumentation for thoracic AIS patients during follow-up. How-ever, the patients with all-hook system may develop thoracic kyphosis and sagittal junctional decompensation because of the instability of instrumentation.