Lenke 5型青少年特发性脊柱侧凸后路固定节段的选择  

Selection of posterior fixation segments for Lenke 5 adolescent idiopathic scoliosis

作　　者：都金鹏 贺宝荣[1] Du Jinpeng;He Baorong(Department of Spine Surgery,Honghui Hospital,Xi′an Jiaotong University,Xi′an 710054,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,西安710054

出　　处：《中华医学杂志》2024年第1期5-9,共5页National Medical Journal of China

摘　　要：随着脊柱外科医师对三维矫形理念的进一步认识,内固定器械、去旋转工具的进步以及手术技术的提高,Lenke 5型青少年特发性脊柱侧凸手术策略的科学制定逐渐成为治疗的争议焦点。术前手术策略的制定不仅直接影响畸形矫正和平衡重建,而且与术后脊柱的活动功能及患者生活质量直接相关。因此本文将从手术固定方法、手术入路、固定椎选择三方面论述。笔者认为,应以Risser征为重要的考量因素来判断手术固定方法。手术入路的选择必须要参考术者对入路的熟悉程度及经验,在把握好适应证并考虑手术风险和益处的同时,根据不同患者的需要选择合适的手术入路。固定椎的选择,选择上端椎(UEV)为上端固定椎(UIV),较更为激进的上端椎-1(UEV-1)更加安全,而在具体选择下端固定椎(LIV)时需要综合五方面因素。With the further understanding of the concept of three-dimensional correction by spinal surgeons,the progress of internal fixation instruments,de-rotation tools and the improvement of surgical techniques,the scientific formulation of surgical strategies for Lenke 5 adolescent idiopathic scoliosis has gradually become the focus of controversy.The formulation of preoperative surgical strategy not only directly affects the correction of deformity and balance reconstruction,but also is directly related to the activity function of spine and the quality of life of patients after operation.Therefore,this paper will discuss from three aspects:the method of surgical fixation,the surgical approach and the selection of fixed vertebrae.The author believes that Risser sign should be taken as an important consideration to judge the method of surgical fixation.The choice of surgical approach must refer to the operator′s familiarity and experience with the approach,grasp the adaptive signs and consider the risks and benefits of the operation,and choose the appropriate surgical approach according to the needs of different patients.The choice of fixed vertebrae,choosing upper end vertebra(UEV)as upper instrumented vertebra(UIV),is safer than the more radical upper end vertebra-1(UEV-1),and five factors need to be combined in the specific selection of lower instrumented vertebra(LIV).

关 键 词：脊柱侧凸 青少年特发性脊柱侧凸 手术策略 固定节段 

分 类 号：R726.8[医药卫生—儿科]