特发性脊柱侧凸King型和型远端融合椎的选择  

SELECTION OF LOW INSTRUMENTATION VERTEBRAE WITH CD HYBRID TECHNIQUE IN KING-TYPES Ⅲ AND Ⅳ SCOLIOSIS

作　　者：张永刚[1] 王岩[1] 张雪松[1] 王征[1] 王冉东[1] 张巍[1] 侯克东[1] 王晋东[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中国修复重建外科杂志》2006年第4期387-390,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 回顾采用椎弓根钩和螺钉CD技术治疗特发性脊柱侧凸KingⅢ型和Ⅳ型患者，分析选择性缩短融合节段的治疗效果。方法2000年3月～2003年1月，治疗58例特发性脊柱侧凸单胸弯患者，男17例，女41例，年龄12～18岁，平均14岁。其中KingⅢ型40例，KingⅣ型18例。胸弯Cobb角平均64°（50～83°），柔韧性62％；腰弯Cobb角平均37°（16～48°），柔韧性105％。腰弯腰骶角平均为17°（10～22°）。所有患者C7重力垂线均不同程度地偏离骶骨中线。采用椎弓根钩和螺钉CD技术矫形治疗，以中立椎为基础选择远端融合椎，所有远端融合节段均未超过中立椎。术后随访摄站立前后位和侧位X线片，观察各项指标的变化。结果患者均获随访1年8个月～3年2个月，平均2．4年，均未出现明显的躯干侧方移位和双肩不平衡。术后Cobb角平均丢失3．1°（-1～5°）；最后随访时，胸弯矫正率68％；除2例C7重力垂线偏离骶骨中线1～2cm外，其余均通过骶骨中线；腰弯腰骶角减少至平均8°（2～13°），矫正率为53％；48例远端融合椎为非稳定椎者术后成为稳定椎。与Harrington远端融合椎选择原则相比，患者远端融合椎平均节省1．4个节段（1～2个节段）。结论采用三维节段性器械内固定系统治疗特发性单胸弯时，以中立椎为基础选择远端融合椎，可获得较好的临床效果。Objective To review the King-types Ⅲ and Ⅳ patients treated by the CD hybrid technique and evaluate clinical results on the shorter fusion levels. Methods Fifty-eight patients with idiopathic scoliosis were treated by the CD hybrid method from March 2000 to January 2003, among whom 40 were grouped as King-type Ⅱ and 18 as King-type Ⅳ ; 41 were female and 17 were male. The Cobb angle of the thoracic curve was averaged 64°（range 50-83°） , and the curve flexibility was 62%. The compensative lumbar curve was averaged 37°（range 16-48°）, and the curve flexibility was 105%. With the neutral rotational vertebrae as a basis to select the low instrumentation vertebrae, the neutral rotational vertebrae or the vertebrae at 1 or 2 levels proximal to the neutral rotational vertebrae were selected as the low instrumentation vertebrae in all the patients. Standing AP and lateral radiographs were taken respectively at the discharge, during the follow-up after discharge, and at the final follow-up. Results The patients were followed up for an average of 2, 4 years （range 1, 8-3.2）. The corrected curves lost an average of 3. 1°（range- 1-5°）and the correction rate of the thoracic curve was 68% at the final follow-up. The plumbline from C7 was parallel to the sacral midline in 56 patients. The lumbar curves were corrected to an average of 8°（2-13°）automatically, The lumbosacral angle was corrected automatically by 53% and the low instrumentation vertebrae in 48 patients turned into stable vertebrae. The low instrumentation vertebrae lost 1. 4 segments on average compared with the Harrington principle. No spinal imbalance was clinically observed in all the patients. Conclusion The choice of the low instrumentation vertebrae as the neutral rotational vertebrae can have a good result in the clinical practice. It can be applied in the CD hybrid technique in treatment of idiopathic thoracic curves.

关 键 词：特发性脊柱侧凸 CD矫形技术 远端融合椎 

分 类 号：R687.3[医药卫生—骨科学]