中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
23期
1811-1814
,共4页
脊柱侧凸%脊柱融合术%肋骨%去旋转
脊柱側凸%脊柱融閤術%肋骨%去鏇轉
척주측철%척주융합술%륵골%거선전
Scoliosis%Spinal fusion%Ribs%Derotation
目的 评价后路多次去旋转治疗重度僵硬性脊柱侧凸的临床效果.方法 回顾性分析2007年8月至2010年7月合肥市第一人民医院脊柱外科行后路多次转棒去旋转技术治疗重度脊柱侧凸14例患者的临床资料,平均年龄16.4(11 ～23)岁.所有患者的诊断得到影像学检查并且由同一组脊柱外科医师证实并行后路一期松解多次转棒去旋转钉棒固定融合术,内固定器械为GSS系统.采用脊柱侧凸研究学会22项(SRS-22)患者量表调查表评价术后终末随访时的疗效.观察术前术后的站立位Cobb's角度数;术前弯曲应力位Cobb's角,脊柱柔韧性测定;术前术后的顶椎偏移距离、冠状面和矢状面平衡;肺功能检测,生化指标;术后是否出现脊髓损伤、神经功能障碍,有无切口感染、迟发性感染和螺钉断裂.结果 所有患者得到随访3～5.5(4.1±0.7)年,均骨性融合,无感染和内固定断裂.固定节段9～13(11.2± 1.2)个椎体.术前脊柱的柔韧度0％ ～ 30％,(12.7％±9.0％).站立位全脊柱正侧位片显示冠状位主弯的Cobb角术前65 ～110°(90.3±13.5)°,应力位片50 ～91°(78.3±12.3)°;术后矫正至10 ～41°,(30.8±9.8)°,终末随访时15～48°(35.5±9.5)°,冠状面平衡由术前(3.2±1.1) cm矫正至术后(0.9±1.0)cm,随访时(1.2±1.1)cm,矢状面平衡由术前(2.3±1.1) cm矫正至术后(0.40±0.51) cm,随访时(0.55±0.51)cm.顶椎偏移由术前(6.4±1.7) cm矫正至术后(2.4±1.2) cm,随访时(2.6±1.4) cm.胸椎后凸(T5-T12)的Cobb角术前(31.1±12.4)°,术后矫正至(25.6±5.5)°,终末随访时(28.6±6.1)°;腰椎前凸(L1-L5)的Cobb角术前(45.5±10.5)°,术后矫正至(33.4±5.5)°,终末随访时(35.3±4.2)°.主弯的Cobb角平均矫正率59.8％,Cobb角丢失3.6°.14例患者矢状面平衡良好,出现冠状面不平衡2例.随访期末14例病例均获得骨性愈合.围手术期并发症2例,1例切口皮缘愈合不良,经过换药处理瘢痕愈合,1例有短期胸1神经损伤出现左上肢上臂内侧疼痛伴有轻度麻木,2周后恢复正常.结论 后路多次转棒去旋转技术降低术中装棒的困难,有效治疗重度僵硬性脊柱侧凸畸形.
目的 評價後路多次去鏇轉治療重度僵硬性脊柱側凸的臨床效果.方法 迴顧性分析2007年8月至2010年7月閤肥市第一人民醫院脊柱外科行後路多次轉棒去鏇轉技術治療重度脊柱側凸14例患者的臨床資料,平均年齡16.4(11 ～23)歲.所有患者的診斷得到影像學檢查併且由同一組脊柱外科醫師證實併行後路一期鬆解多次轉棒去鏇轉釘棒固定融閤術,內固定器械為GSS繫統.採用脊柱側凸研究學會22項(SRS-22)患者量錶調查錶評價術後終末隨訪時的療效.觀察術前術後的站立位Cobb's角度數;術前彎麯應力位Cobb's角,脊柱柔韌性測定;術前術後的頂椎偏移距離、冠狀麵和矢狀麵平衡;肺功能檢測,生化指標;術後是否齣現脊髓損傷、神經功能障礙,有無切口感染、遲髮性感染和螺釘斷裂.結果 所有患者得到隨訪3～5.5(4.1±0.7)年,均骨性融閤,無感染和內固定斷裂.固定節段9～13(11.2± 1.2)箇椎體.術前脊柱的柔韌度0％ ～ 30％,(12.7％±9.0％).站立位全脊柱正側位片顯示冠狀位主彎的Cobb角術前65 ～110°(90.3±13.5)°,應力位片50 ～91°(78.3±12.3)°;術後矯正至10 ～41°,(30.8±9.8)°,終末隨訪時15～48°(35.5±9.5)°,冠狀麵平衡由術前(3.2±1.1) cm矯正至術後(0.9±1.0)cm,隨訪時(1.2±1.1)cm,矢狀麵平衡由術前(2.3±1.1) cm矯正至術後(0.40±0.51) cm,隨訪時(0.55±0.51)cm.頂椎偏移由術前(6.4±1.7) cm矯正至術後(2.4±1.2) cm,隨訪時(2.6±1.4) cm.胸椎後凸(T5-T12)的Cobb角術前(31.1±12.4)°,術後矯正至(25.6±5.5)°,終末隨訪時(28.6±6.1)°;腰椎前凸(L1-L5)的Cobb角術前(45.5±10.5)°,術後矯正至(33.4±5.5)°,終末隨訪時(35.3±4.2)°.主彎的Cobb角平均矯正率59.8％,Cobb角丟失3.6°.14例患者矢狀麵平衡良好,齣現冠狀麵不平衡2例.隨訪期末14例病例均穫得骨性愈閤.圍手術期併髮癥2例,1例切口皮緣愈閤不良,經過換藥處理瘢痕愈閤,1例有短期胸1神經損傷齣現左上肢上臂內側疼痛伴有輕度痳木,2週後恢複正常.結論 後路多次轉棒去鏇轉技術降低術中裝棒的睏難,有效治療重度僵硬性脊柱側凸畸形.
목적 평개후로다차거선전치료중도강경성척주측철적림상효과.방법 회고성분석2007년8월지2010년7월합비시제일인민의원척주외과행후로다차전봉거선전기술치료중도척주측철14례환자적림상자료,평균년령16.4(11 ～23)세.소유환자적진단득도영상학검사병차유동일조척주외과의사증실병행후로일기송해다차전봉거선전정봉고정융합술,내고정기계위GSS계통.채용척주측철연구학회22항(SRS-22)환자량표조사표평개술후종말수방시적료효.관찰술전술후적참립위Cobb's각도수;술전만곡응력위Cobb's각,척주유인성측정;술전술후적정추편이거리、관상면화시상면평형;폐공능검측,생화지표;술후시부출현척수손상、신경공능장애,유무절구감염、지발성감염화라정단렬.결과 소유환자득도수방3～5.5(4.1±0.7)년,균골성융합,무감염화내고정단렬.고정절단9～13(11.2± 1.2)개추체.술전척주적유인도0％ ～ 30％,(12.7％±9.0％).참립위전척주정측위편현시관상위주만적Cobb각술전65 ～110°(90.3±13.5)°,응력위편50 ～91°(78.3±12.3)°;술후교정지10 ～41°,(30.8±9.8)°,종말수방시15～48°(35.5±9.5)°,관상면평형유술전(3.2±1.1) cm교정지술후(0.9±1.0)cm,수방시(1.2±1.1)cm,시상면평형유술전(2.3±1.1) cm교정지술후(0.40±0.51) cm,수방시(0.55±0.51)cm.정추편이유술전(6.4±1.7) cm교정지술후(2.4±1.2) cm,수방시(2.6±1.4) cm.흉추후철(T5-T12)적Cobb각술전(31.1±12.4)°,술후교정지(25.6±5.5)°,종말수방시(28.6±6.1)°;요추전철(L1-L5)적Cobb각술전(45.5±10.5)°,술후교정지(33.4±5.5)°,종말수방시(35.3±4.2)°.주만적Cobb각평균교정솔59.8％,Cobb각주실3.6°.14례환자시상면평형량호,출현관상면불평형2례.수방기말14례병례균획득골성유합.위수술기병발증2례,1례절구피연유합불량,경과환약처리반흔유합,1례유단기흉1신경손상출현좌상지상비내측동통반유경도마목,2주후회복정상.결론 후로다차전봉거선전기술강저술중장봉적곤난,유효치료중도강경성척주측철기형.
Objective To explore the outcomes of multiple derotation plus costotransversectomy for patients with severe and rigid scoliosis.Methods Clinical analyses were conducted for the clinical data of operative duration,blood loss volume and SRS-22 scale.Radiographic data included Cobb angle of coronal curves,apical vertebral translation,coronal balance and sagittal balance.All measurements were taken preoperation,post-operation and during the final follow-up period.Results The mean follow-up period was 4.1 ±0.7 (3-5.5) years,mean operative duration 33 ± 8.4 min and mean blood loss volume 2303.5 ±9.0 ml.Preoperative major curves ranged from 65° to 110 °Cobb angle.Coronal plane correction of major curve from 10 °to 41° Cobb angle (mean 30.8 ±9.8°).And there was a mean loss of correction of 3.6％ during the final follow-up.The magnitudes of thoracic kyphosis and lumbar lordosis were 31.1 ± 12.4°,45.5 ± 10.5° pre-operation,25.6 ± 5.5°,33.43 ± 5.45° post-operation and 28.6 ± 6.1 °,35.26 ± 4.2° during the final follow-up.The apical vertebral translation of major curve was corrected by 73.2％.The coronal imbalance,sagittal imbalance and apical vertebral translation indifferently was 3.2 ± 1.1,2.3 ± 1.1,6.35 ± 1.65 cm pre-operation,0.9 ± 1.0,0.4 ±0.5,2.4 ± 1.2 cm post-operation and 1.2 ± 1.1,0.6 ± 0.5,2.6 ± 1.4 cm during the final follow-up.Incomplete thoracic nerve dysfuction occurred in one case and superficial dermatoedge necrosis in another recovered within 2 weeks.Neither malposition of pedicle screw nor complication of instrumentation was found.Excellent outcomes were obtained according to SRS-22 score.Conclusion For patients with severe and rigid scoliosis,the technique of multi-rodderotation and rib resection may achieve a good correction of scoliosis without serious complications and avoid a resection of vertebral column.
