脊柱侧凸前路矫形固定术后椎间角的变化及下融合椎后滑移  

The changes of the intervertebral angle and retrolisthesis of the last instrumented vertebrae after anterior correction and instrumentation in adolescent idiopathic scoliosis

作　　者：王以朋[1] 于斌[1] 邱贵兴[1] 仉建国[1] 徐宏光[1] 沈建雄[1] 李其一[1] 杨新宇[1] 赵丽娟[1] 

机构地区：[1]北京协和医院骨科,100730

出　　处：《中华骨科杂志》2005年第6期353-358,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨特发性脊柱侧凸前路矫形内固定术后椎间角的变化及下融合椎后滑移的发生情况。方法回顾性分析近4年来我院青少年特发性脊柱侧凸患者接受前路矫形内固定手术前后及随访时的X线片,对侧凸Cobb角、侧凸矫形率、躯干偏移、下融合椎旋转度、下融合椎相对于骨盆的倾斜度、椎间角及下融合椎后滑移等参数进行测量分析。结果50例患者符合入选标准,主侧凸位于胸腰段或腰段。手术前后主弯冠状面Cobb角分别为47.78°±9.39°和10.32°±8.50°,侧凸矫形率平均79.05%。手术前后下融合椎旋转度分别为1.54°±0.58°及1.06°±0.47°。手术前后下融合椎相对于骨盆的倾斜度分别为23.80°±7.91°和9.16°±9.46°。椎间角术前平均为3.72°±3.05°,Bending相上为-2.22°±5.85°,术后即刻为1.56°±5.97°,较术前明显改善(P=0.029);末次随访时为4.87°±7.95°,与术后即刻相比差异有统计学意义(P=0.038)。术后19例(38%)患者发生下融合椎后滑移,平均滑移距离(4.79±1.75)mm。发生与未发生后滑移的患者在术前顶椎旋转度及Bending相椎间角的差异均有统计学意义(P=0.047,0.033)。结论特发性脊柱侧凸前路矫形内固定术后椎间角较术前明显改善,但在随访时椎间角又逐渐增大。Objective To investigate the changes of the intervertebral angle and retrolisthesis of the last instrumented vertebrae (LIV) after anterior correction and instrumentation in adolescent idiopathic scoliosis patients. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic scoliosis patients who underwent anterior correction and instrumentation in recent 4 years, their Cobb angle of the curve, correction rate, trunk shift, LIV rotation, obliquity between LIV and the pelvis, intervertebral angle and retrolisthesis of the LIV were measured and analyzed. Results There were total 50 patients included. The apex of the main curve was located at thoracolumbar junction or lumbar spine. The coronal Cobb angle of the main curve were 47.78°±9.39° and 10.32°±8.50° before and after surgery respectively, with an average correction rate of 79.05%. The average rotation of LIV before surgery was 1.54°±0.58°, and improved to 1.06°±0.47° after surgery. The obliquity between LIV and the pelvis before and after surgery were 23.80°±7.91° and 9.16°±9.46° respectively. The intervertebral angle was 3.72°±3.05° before surgery, and -2.22°±5.85° on Bending films, 1.56°±5.97° after surgery respectively. The changes were of significance in the intervertebral angle after surgery compared with that before surgery(P=0.029). The angle was 4.87°±7.95° at final follow up, the change was also significant compared with that after surgery(P=0.038). 19 patients had LIV retrolisthesis postoperatively, and the average retrolisthesis distance was (4.79±1.75) mm. There were significant differences between the patients with retrolisthesis and the patients without retrolisthesis in apical vertebral rotation and intervertebral angle on Bending films(P=0.047 and P=0.033) respectively. Conclusion The intervertebral angle is much improved after anterior correction and instrumentation surgery, but it increases gradually at follow up. The retrolisthesis of LIV may be correlated with the apical vertebral rot

关 键 词：前路矫形 融合 椎间 滑移 青少年特发性脊柱侧凸 内固定术后 COBB角 手术前后 回顾性分析 旋转度 发生情况 测量分析 倾斜度 统计学 患者 X线片 随访 胸腰段 冠状面 平均 骨盆 后下 即刻 顶椎 

分 类 号：R687[医药卫生—骨科学]