CAJ | 학술논문

目的评价选择性胸椎融合治疗脊柱侧凸并脊髓空洞症的效果.方法对2001年1月至2009年1月收治的93例脊柱侧凸并脊髓空洞症患者进行回顾性分析,其中行选择性胸椎融合且术后随访超过2年的患者共11例,男性3例,女性8例;年龄9～21岁,平均14.9岁.侧凸类型包括双弯9例,三弯2例.术前、术后及随访时行X线片检查,对侧凸类型、侧凸Cobb角、顶椎旋转度、顶椎偏距、侧凸柔韧性、躯干偏移进行测量和分析.结果术前胸腰凸或腰凸Lenke A型2例,LenkeB型7例,Lenke C型2例.手术前后胸凸Cobb角平均值分别为62.6°和19.0°,平均矫正率为69.6%;手术前后胸腰凸或腰凸Cobb角分别为36.1°和11.6°,自动矫正率为67.9%,随访时间24～48个月,平均29.5个月,胸凸矫正丢失率为6.8%.最终随访时有1例发生了冠状面躯干失平衡,有1例发生椎弓根螺钉螺帽脱出,行翻修手术,无神经系统并发症发生.结论选择性胸椎融合可用于脊柱侧凸并脊髓空洞症患者的手术治疗,这类患者的胸腰凸或腰凸具有与特发性脊柱侧凸类似的自发矫形能力,参照特发性脊柱侧凸的选择性融合标准可获得良好效果.
목적 평개선택성흉추융합치료척주측철병척수공동증적효과.방법 대2001년1월지2009년1월수치적93례척주측철병척수공동증환자진행회고성분석,기중행선택성흉추융합차술후수방초과2년적환자공11례,남성3례,녀성8례;년령9～21세,평균14.9세.측철류형포괄쌍만9례,삼만2례.술전、술후급수방시행X선편검사,대측철류형、측철Cobb각、정추선전도、정추편거、측철유인성、구간편이진행측량화분석.결과 술전흉요철혹요철Lenke A형2례,LenkeB형7례,Lenke C형2례.수술전후흉철Cobb각평균치분별위62.6°화19.0°,평균교정솔위69.6%;수술전후흉요철혹요철Cobb각분별위36.1°화11.6°,자동교정솔위67.9%,수방시간24～48개월,평균29.5개월,흉철교정주실솔위6.8%.최종수방시유1례발생료관상면구간실평형,유1례발생추궁근라정라모탈출,행번수수술,무신경계통병발증발생.결론 선택성흉추융합가용우척주측철병척수공동증환자적수술치료,저류환자적흉요철혹요철구유여특발성척주측철유사적자발교형능력,삼조특발성척주측철적선택성융합표준가획득량호효과.
Objective To evaluate the surgical results of selective thoracic fusion(STF)for scoliosis associated with syringomyelia Methods From January 2001 to January 2009,93 cases of scoliosis associated with syringomyelia were retrospectively reviewed.There were 11 cases who underwent STF and were followed up more than 2 years,which included 8 female and 3 male,the mean age was 14.9 years (9-21 years).Curve type,coronal and sagittal Cobb angle,apical vertebral rotation apical vertebral translation,flexibility,trunk shift were recorded and analyzed.Results There were 9 double curves and 2 triple curves,the Lenke type of thoracolumbar/lumbar curve included Lenke A in 2 cases,Lenke B in 7 cases and Lenke C in 2 cases.The average coronal Cobb angle of thoracic curve before and after surgery were 62.6°and 19.0° respectively,and the average correction rate was 69.6%.The average coronal Cobb angle of thoracolumbar/lumbar curve before and after surgery were 36.1° and 11.6° respectively,and the average spontaneous correction rate was 67.9%.The followed up time ranged from 24 to 48 months(mean 29.5 months),the average loss of correction rate was 6.8%.Only one trunk decompensation was noted at final follow-up.Pedicle screw nut loosening occurred in one patient and this patient underwent revision surgery,no neurological complication was noted at final follow-up.Conclusions STF could be safely performed in scoliosis associated with syringomyelia.Thoracolumbar/lumbar curve in these patients has similar spontaneous correction ability compared with idiopathic scoliosis patients.The satisfactory result could be achieved according to the STF criteria for IS.