中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2010年
6期
415-418
,共4页
沈建雄%梁锦前%邱贵兴%王以朋
瀋建雄%樑錦前%邱貴興%王以朋
침건웅%량금전%구귀흥%왕이붕
脊柱侧凸%青少年%脊柱融合术%外科手术
脊柱側凸%青少年%脊柱融閤術%外科手術
척주측철%청소년%척주융합술%외과수술
Scoliosis%Adolescent%Spinal fusion%Surgical procedures
目的 论证一种新的青少年特发性脊柱侧凸(AIS)患者远端融合椎的选择方法,评估其临床疗效.方法 运用新的远端融合椎选择标准,前瞻性研究2005年7月至2008年9月接受诊治且符合人组条件的AIS患者31例,平均年龄15.6岁(12～19岁),平均随访27.5个月(12～49个月).观察术前、术后以及末次随访时冠状面的侧凸Cobb角、远端融合椎倾斜角、远端融合椎椎间角、C_7椎体中心至骶骨中垂线的距离(C_7-CSVL)、胸后凸、腰前凸等变化,并进行统计学分析.结果 术前、术后即刻冠状面胸弯Cobb角分别为(42±17)°和(12±7)°,侧凸矫形率平均70.6%;冠状面腰弯Cobb角分别为(44±7)°和(9±4)°,侧凸矫形率平均80.2%;C_7-CSVL分别为(13±8)和(9±7)mm,差异有统计学意义(P<0.05);远端融合椎倾斜角分别为(20.8±5.7)°和(1.5±3.1)°,术后较术前明显改善(P=0.000).末次随访时患者胸弯Cobb角为(14±8)°,腰弯cobb角为(9±5)°,C_7-CSVL为(6±5)mm,与术前比较差异均有统计学意义(P<0.05).末次随访远端融合椎倾斜角为(0.8±3.7)°,与术后即刻相比差异无统计学意义(P>0.05).结论 运用远端椎旋转度数和远端椎柔韧性选择远端融合椎的方法手术治疗AIS是安全、有效的.
目的 論證一種新的青少年特髮性脊柱側凸(AIS)患者遠耑融閤椎的選擇方法,評估其臨床療效.方法 運用新的遠耑融閤椎選擇標準,前瞻性研究2005年7月至2008年9月接受診治且符閤人組條件的AIS患者31例,平均年齡15.6歲(12～19歲),平均隨訪27.5箇月(12～49箇月).觀察術前、術後以及末次隨訪時冠狀麵的側凸Cobb角、遠耑融閤椎傾斜角、遠耑融閤椎椎間角、C_7椎體中心至骶骨中垂線的距離(C_7-CSVL)、胸後凸、腰前凸等變化,併進行統計學分析.結果 術前、術後即刻冠狀麵胸彎Cobb角分彆為(42±17)°和(12±7)°,側凸矯形率平均70.6%;冠狀麵腰彎Cobb角分彆為(44±7)°和(9±4)°,側凸矯形率平均80.2%;C_7-CSVL分彆為(13±8)和(9±7)mm,差異有統計學意義(P<0.05);遠耑融閤椎傾斜角分彆為(20.8±5.7)°和(1.5±3.1)°,術後較術前明顯改善(P=0.000).末次隨訪時患者胸彎Cobb角為(14±8)°,腰彎cobb角為(9±5)°,C_7-CSVL為(6±5)mm,與術前比較差異均有統計學意義(P<0.05).末次隨訪遠耑融閤椎傾斜角為(0.8±3.7)°,與術後即刻相比差異無統計學意義(P>0.05).結論 運用遠耑椎鏇轉度數和遠耑椎柔韌性選擇遠耑融閤椎的方法手術治療AIS是安全、有效的.
목적 론증일충신적청소년특발성척주측철(AIS)환자원단융합추적선택방법,평고기림상료효.방법 운용신적원단융합추선택표준,전첨성연구2005년7월지2008년9월접수진치차부합인조조건적AIS환자31례,평균년령15.6세(12～19세),평균수방27.5개월(12～49개월).관찰술전、술후이급말차수방시관상면적측철Cobb각、원단융합추경사각、원단융합추추간각、C_7추체중심지저골중수선적거리(C_7-CSVL)、흉후철、요전철등변화,병진행통계학분석.결과 술전、술후즉각관상면흉만Cobb각분별위(42±17)°화(12±7)°,측철교형솔평균70.6%;관상면요만Cobb각분별위(44±7)°화(9±4)°,측철교형솔평균80.2%;C_7-CSVL분별위(13±8)화(9±7)mm,차이유통계학의의(P<0.05);원단융합추경사각분별위(20.8±5.7)°화(1.5±3.1)°,술후교술전명현개선(P=0.000).말차수방시환자흉만Cobb각위(14±8)°,요만cobb각위(9±5)°,C_7-CSVL위(6±5)mm,여술전비교차이균유통계학의의(P<0.05).말차수방원단융합추경사각위(0.8±3.7)°,여술후즉각상비차이무통계학의의(P>0.05).결론 운용원단추선전도수화원단추유인성선택원단융합추적방법수술치료AIS시안전、유효적.
Objective To investigate the efficacy and safety of a new method which determines the exact distal fusion level in the treatment of adolescent idiopathic scoliosis (AIS) with posterior pedicle screw fixation and to assess its clinical outcome. Methods This prospective clinical study analyzed 31 AIS patients who met the inclusion criteria enrolled from July 2005 to September 2008. Based on the principle of our new criteria for selection of distal fusion level of AIS, all patients had posterior spinal fusion and instrumentation with pedicle screws. Cobb angle of the curve,tilt angle of the LIV, intervertebral angle and trunk shift were measured and analyzed. Results Preoperative (42 ± 17)° of thoracic curve was corrected to (12±7)°, with a curve correction of 70. 6%. Preoperative (44 ±7)° of lumbar curve was corrected to ( 9 ± 4) °, with a curve correction of 80. 2%. The trunk shift were significantly improved from (13 ± 8 ) mm to (9 ±7) mm before and after surgery respectively (P <0. 05). The tilt angles of the LIV before and after surgery were (20. 8 ± 5. 7) ° and (1.5 ± 3. 1) ° respectively. The thoracic Cobb angle was (14 ± 8) ° and the lumbar Cobb angle was (9 ±5) ° at latest follow up. The changes were of significance in the tilt angle of the LIV after surgery compared with that before surgery (P = 0. 000). This angle averaged (0. 8 ± 3. 7) ° at final follow up, but the change was not significant compared with that after surgery(P >0. 05). Conclusion This is an effective method with the advantage of shortening the fusion level, reserving the distal motion segments and easing segmental degeneration adjacent to the fusion area.
