CAJ | 학술논문

目的探讨一期后路Ponte截骨置钉二期后路矫形在治疗重度僵硬型脊柱侧凸中的疗效及安全性.方法回顾性分析2010年6月至2012年12月接受一期后路Ponte截骨二期后路矫形治疗的Cobb角大于100°的僵硬型脊柱侧凸患者24例,男9例,女15例;年龄14～30岁,平均(21.4±4.1)岁.术前冠状面主弯Cobb角106°～156°,平均125.8°;后凸角59°～141°,平均100.1°.一期后路Ponte截骨松解、置钉,术后Halo-股骨髁上牵引,再行二期后路置棒矫形融合术.比较术前站立位、后路松解牵引后仰卧位、术后及末次随访的冠状面主弯Cobb角.结果术前仰卧Bending位主弯侧凸柔韧性为14.8％±7.5％;后路松解牵引后主弯侧凸柔韧性为29.1％±9.9％;较术前平均提高14.3％,差异有统计学意义.后路矫形术后主弯Cobb角平均74.4°±14.5°,矫正率平均41.0％±8.1％;与术前仰卧Bending位和松解牵引后比较矫正率分别提高了26.2％和11.9％,差异有统计学意义.术后随访15～36个月,平均(24.0±5.9)个月.末次随访时主弯Cobb角平均丢失1.4°.术后后凸角平均53.0°±13.7°,较术前(100.1°±23.7°)明显改善,矫正率平均46.1％±11.9％,末次随访时无矫正丢失.牵引中1例发生左侧股骨髁上钉道感染,2例发生左下肢静脉血栓.结论后路Ponte截骨松解+Halo-股骨髁上牵引能够使重度僵硬型脊柱侧凸患者获得满意的矫正率,但应注意下肢静脉血栓形成的风险.
목적 탐토일기후로Ponte절골치정이기후로교형재치료중도강경형척주측철중적료효급안전성.방법 회고성분석2010년6월지2012년12월접수일기후로Ponte절골이기후로교형치료적Cobb각대우100°적강경형척주측철환자24례,남9례,녀15례;년령14～30세,평균(21.4±4.1)세.술전관상면주만Cobb각106°～156°,평균125.8°;후철각59°～141°,평균100.1°.일기후로Ponte절골송해、치정,술후Halo-고골과상견인,재행이기후로치봉교형융합술.비교술전참립위、후로송해견인후앙와위、술후급말차수방적관상면주만Cobb각.결과 술전앙와Bending위주만측철유인성위14.8％±7.5％;후로송해견인후주만측철유인성위29.1％±9.9％;교술전평균제고14.3％,차이유통계학의의.후로교형술후주만Cobb각평균74.4°±14.5°,교정솔평균41.0％±8.1％;여술전앙와Bending위화송해견인후비교교정솔분별제고료26.2％화11.9％,차이유통계학의의.술후수방15～36개월,평균(24.0±5.9)개월.말차수방시주만Cobb각평균주실1.4°.술후후철각평균53.0°±13.7°,교술전(100.1°±23.7°)명현개선,교정솔평균46.1％±11.9％,말차수방시무교정주실.견인중1례발생좌측고골과상정도감염,2례발생좌하지정맥혈전.결론 후로Ponte절골송해+Halo-고골과상견인능구사중도강경형척주측철환자획득만의적교정솔,단응주의하지정맥혈전형성적풍험.
Objective To discuss the efficacy and safety of one-stage posterior Ponte osteotomy and two-stage posterior orthopedics in treatment of severe rigid scoliosis.Methods Retrospective review was conducted for 24 patients with severerigid scoliosis (Cobb angle ＞100°) who underwent one-stage posterior Ponte osteotomy and two-stage posterior orthopedics between June 2010 and December 2012,including 9 male patients and 15 female patients.The average age is 21.4±4.1 (ranging from 14 to 30).The major curve Cobb angle on preoperative coronal plane was 106°-156° (125.8° on the average);kyphosis angle was 59°-141° (100.1° on the average).All patients experienced one-stage posterior Ponte osteotomy,screw insertion,postoperative Haloskeletal traction through supracondyle of femur and two-stage posterior orthopedic fusion.The Cobb angles of the major curve at the standing position before surgery,at supine position after posterior release and traction and on postoperative coronal plane and on coronal plane in the last follow-up.Results The flexibility of major curve at bending position before the surgery was 14.8％±7.5％;the flexibility of major curve after posterior release and traction was 29.1％±9.9％;it improves 14.3％ compared with that before the surgery.The difference has statistical significance.The Cobb angle of major curve after posterior orthopedics was 74.4°±14.5° on the average;the mean correction rate was 41.0％±8.1％.It boots 26.2％ and 11.9％ respectively compared with preoperative bending position and posterior release and traction.The different has statistical significance.The postoperation follow-up duration was 15-36 months (24.0±5.9 months on the average).At the last follow-up,the average loss of Cobb angle of major curve was 1.4°.The post-operative kyphosis angle was 53.0°±13.7° on the average which significantly improves compared with pre-operation (100.1°±23.7°).The mean correction rate was 46.1％± 11.9％.No correction loss was shown in the last follow-up.One patient experienced superficial pin-site infection and two patients had deep venous thrombosis of the left limb.Conclusion Posterior Ponte osteotomy combined with Halo-femoral traction could achieve satisfactory correction rate for patients with severe rigid scoliosis.However,the risk caused by thrombus of lower extremity veins should be noticed during the whole procedure.