CAJ | 학술논문

目的探讨在重度僵硬性脊柱侧凸后路矫形手术中进行广泛松解对脊柱矢状面矫形效果的影响.方法回顾分析2006至2009年收治的37例采用脊柱后路椎弓根钉棒系统矫治的重度僵硬性脊柱侧凸病例,其中女26例,男11例,手术时年龄在14 ～ 22岁,平均17.3岁,主胸弯Cobb角在70～ 100°之间.按照术中脊柱后方结构的松解方法,将病人分为两组.A组为后路广泛松解,选择主胸弯顶椎附近的3个节段行Ponte截骨术,其余所有节段行下关节突切除术,共15例；B组为后路单纯软组织松解,共22例.根据术前胸椎后凸角(TKA)大小,进一步将A组病例分为A1亚组(术前TKA＜ 40°),A2亚组(术前TKA＞ 40°),将B组病例分为B1亚组(术前TKA＜ 40°),B2亚组(术前TKA＞ 40°),回顾术前、术后和随访时脊柱站立位正侧位X线片以及相关临床资料,比较两种松解方法在胸椎矢状面的矫形效果差异.结果所有手术顺利完成.两组的手术时间差异无统计学意义(P＞0.05),A组术中失血量大于B组(P＜0.05)；A组术后冠状面Cobb角矫正至平均27.4°,矫正率为68.1％;B组术后冠状面Cobb角矫正至平均35.6°,矫正率为56.9％.A1亚组术后胸椎后凸角平均26.8°,平均增加9.2°,B1亚组术后胸椎后凸角平均12.5°,平均丢失3.1°,两亚组术后胸椎后凸角变化差异有统计学意义(P ＜0.05)；A2亚组术后胸椎后凸角平均28.4°,平均矫正24.9°,B2亚组术后胸椎后凸角平均39.1°,平均矫正10.3°,两亚组术后胸椎后凸角变化差异有统计学意义(P＜0.05).无神经损伤、深部感染和内固定失败等严重并发症发生.所有病例随访2年,无明显矫形丢失,外观和躯干平衡均获得明显改善.结论在重度僵硬性脊柱侧凸后路矫形手术中,广泛的松解有助于恢复正常的胸椎后凸,同时可以增加主胸弯冠状面矫正率.
목적 탐토재중도강경성척주측철후로교형수술중진행엄범송해대척주시상면교형효과적영향.방법 회고분석2006지2009년수치적37례채용척주후로추궁근정봉계통교치적중도강경성척주측철병례,기중녀26례,남11례,수술시년령재14 ～ 22세,평균17.3세,주흉만Cobb각재70～ 100°지간.안조술중척주후방결구적송해방법,장병인분위량조.A조위후로엄범송해,선택주흉만정추부근적3개절단행Ponte절골술,기여소유절단행하관절돌절제술,공15례；B조위후로단순연조직송해,공22례.근거술전흉추후철각(TKA)대소,진일보장A조병례분위A1아조(술전TKA＜ 40°),A2아조(술전TKA＞ 40°),장B조병례분위B1아조(술전TKA＜ 40°),B2아조(술전TKA＞ 40°),회고술전、술후화수방시척주참립위정측위X선편이급상관림상자료,비교량충송해방법재흉추시상면적교형효과차이.결과 소유수술순리완성.량조적수술시간차이무통계학의의(P＞0.05),A조술중실혈량대우B조(P＜0.05)；A조술후관상면Cobb각교정지평균27.4°,교정솔위68.1％;B조술후관상면Cobb각교정지평균35.6°,교정솔위56.9％.A1아조술후흉추후철각평균26.8°,평균증가9.2°,B1아조술후흉추후철각평균12.5°,평균주실3.1°,량아조술후흉추후철각변화차이유통계학의의(P ＜0.05)；A2아조술후흉추후철각평균28.4°,평균교정24.9°,B2아조술후흉추후철각평균39.1°,평균교정10.3°,량아조술후흉추후철각변화차이유통계학의의(P＜0.05).무신경손상、심부감염화내고정실패등엄중병발증발생.소유병례수방2년,무명현교형주실,외관화구간평형균획득명현개선.결론 재중도강경성척주측철후로교형수술중,엄범적송해유조우회복정상적흉추후철,동시가이증가주흉만관상면교정솔.
Objective To explore the effects of wide posterior release on the correction of severe and rigid thoracic scoliosis in sagittal plane.Methods A total of 37 idiopathic scoliosis patients (26 females and 11 males) with severe and rigid thoracic curves corrected with posterior pedicle screw system between 2006 and 2009 were recruited.Their average age was 17.3 years (range:14-22) at operation and the thoracic Cobb angle was between 70-100°.They were separated into 2 groups:group A (n =15) with wide posterior release and group B (n =22) with posterior soft tissue release alone.The preoperative,postoperative and latest standing posteroanterior and lateral radiographs during follow-ups were reviewed.Results All patients were operated successfully.No statistic difference existed in the average operative duration between two groups(P ＞ 0.05).The average volume of blood loss was 874 ml in Group A versus 712 ml in Group B(P ＜ 0.05).The average coronal Cobb angle on postoperative standing photograph was 27.4°(68.1％ correction) in Group A and 35.6°(56.9％ correction) in Group B.For comparing sagittal correction results in patients with similar thoracic sagittal deformities,we distinguished subgroup A1 (preoperative TKA ＜ 40°) from subgroup A2 (preoperative TKA ＞ 40°) in group A and subgroup B1 (preoperative TKA ＜40°) from subgroup B2 (preoperative TKA ＞40°) in group B.The postoperative TKA was 26.8°(＞9.2°than preoperation) in subgroup A1 and 12.5° (3.1° ＜ preoperation) in subgroup B1(P ＜ 0.05).The postoperative TKA was 28.4 ° (24.9 ° ＜ preoperation) in subgroup A2 and 39.1 o (1 0.3 ° ＜preoperation) in subgroup B2 (P ＜ 0.05).There was one case of dural leakage in group A.A leakage of cerebrospinal fluid was cured with a prone position and wound compression.One case of infection in superficial part of wound in group B was cured after debridement.No nerve system injury,deep infection or instrumentation failure was found.During a follow-up period of 2 years,there was no obvious correction loss or trunk decompensation.Conclusion In idiopathic scoliosis patients with severe and rigid thoracic curves,wide posterior release via a posterior approach may help to correct the deformity in sagittal plan and achieve more coronal correction in these curves.