CAJ | 학술논문

目的评估后路截骨短节段融合术联合双棒生长棒技术治疗严重、僵硬先天性脊柱侧凸的初步疗效.方法回顾性研究2006年至2011年行截骨短节段融合联合双棒生长棒技术治疗7例先天性脊柱侧凸患者资料,男2例,女5例;年龄2～10岁,平均5.9岁;Risser征均为0度.记录患儿年龄、撑开次数及并发症.对影像学资料进行测量分析,测量指标包括在站立位全脊柱正侧位X线片上侧凸Cobb角、胸后凸、腰前凸、T1～S1距离及内固定的长度,对畸形的矫正情况以及脊柱、胸廓的生长状况进行评估.结果 7例患儿共接受后路截骨短节段融合联合生长棒手术48次,其中41次为撑开术,平均每例患儿经历5.9次撑开术.7例患儿均获得随访,随访时间36～83个月,平均为59.4个月.冠状面主弯度数术前81.4°,术后40.1°,末次随访时41.1°.T1～S1从术前23.7 cm增至术后的27.0 cm,末次随访时为32.8 cm,平均年增长率为1.12 cm/年.内固定节段初次手术术后为20.5 cm,末次随访时为25.0 cm.坎贝尔的空间供肺比值(Campbell's spaceavailable for lung ratio,SAL),术前为0.87,术后改善至0.95,末次随访时为0.97.1例患儿因脊柱生长致生长棒可撑开部分不足接受换棒术.末次随访时,无一例患儿发生并发症.结论截骨短节段融合联合双棒生长棒技术治疗严重、僵硬先天性脊柱侧凸安全、有效,可在维持矫形的同时,保留大部分脊柱的生长潜力,但是该技术创伤较大、手术难度较高、需多次手术.
목적 평고후로절골단절단융합술연합쌍봉생장봉기술치료엄중、강경선천성척주측철적초보료효.방법 회고성연구2006년지2011년행절골단절단융합연합쌍봉생장봉기술치료7례선천성척주측철환자자료,남2례,녀5례;년령2～10세,평균5.9세;Risser정균위0도.기록환인년령、탱개차수급병발증.대영상학자료진행측량분석,측량지표포괄재참립위전척주정측위X선편상측철Cobb각、흉후철、요전철、T1～S1거리급내고정적장도,대기형적교정정황이급척주、흉곽적생장상황진행평고.결과 7례환인공접수후로절골단절단융합연합생장봉수술48차,기중41차위탱개술,평균매례환인경력5.9차탱개술.7례환인균획득수방,수방시간36～83개월,평균위59.4개월.관상면주만도수술전81.4°,술후40.1°,말차수방시41.1°.T1～S1종술전23.7 cm증지술후적27.0 cm,말차수방시위32.8 cm,평균년증장솔위1.12 cm/년.내고정절단초차수술술후위20.5 cm,말차수방시위25.0 cm.감패이적공간공폐비치(Campbell's spaceavailable for lung ratio,SAL),술전위0.87,술후개선지0.95,말차수방시위0.97.1례환인인척주생장치생장봉가탱개부분불족접수환봉술.말차수방시,무일례환인발생병발증.결론 절골단절단융합연합쌍봉생장봉기술치료엄중、강경선천성척주측철안전、유효,가재유지교형적동시,보류대부분척주적생장잠력,단시해기술창상교대、수술난도교고、수다차수술.
Objective To evaluate the clinical outcomes of the hybrid technique of posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis.Methods Seven patients (2males,5 females) undergoing this hybrid technique for severe rigid congenital scoliosis in our hospital from 2006 to 2011 were retrospectively studied.The average age was 5.9 years (range,2-10).The Risser sign of all the patients was 0.The follow-up time was 59.4 months (range,36-83 months).The patients' charts were reviewed.The analysis included age at initial surgery and the latest follow-up,number and frequency of lengthening,and complications.Radiographic evaluation included measured changes in scoliosis Cobb angle,thoracic kyphosis,lumbar lordosis,trunk shift,length of T1-S1 and instrumentation.Results All patients were treated with posterior osteotomy with short segmental fusion and dual growing rod technique.There were 48 total surgeries,41 of which were lengthening procedures,for 7 patients.The average lengthening was 5.9 per patient.The mean scoliosis improved from 81.4° to 40.1 ° after initial surgery and was 41.1 ° at the final follow-up.The average T1-S1 length was of 1.12 cm per year.The Campbell's space available for lung ratio increased from 0.87 to 0.97.Conclusion Osteotomy with short fusion could help to improve the correction of the growing rod and eliminate the large asymmetric growth potential around the apex,with little influence to the length of the spine.Dual growing rod technique could maintain correction achieved at initial surgery while allowing spinal growth to continue.However,this technique is relatively more aggressive and technique demanding.And the patients need numbers of surgeries.