前后路联合三维矫形手术治疗青少年特发性僵硬型胸椎侧凸  

Anterior release and three-dimensional posterior correction for the treatment of rigid thoracic adolescent idiopathic scoliosis

作　　者：闫伟强[1] 贺西京[2] 

机构地区：[1]天津市第一中心医院骨科 [2]西安交通大学第二附属医院骨二科

出　　处：《中国骨伤》2007年第4期247-250,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:评价前路松解联合后路三维矫形治疗青少年特发性僵硬型胸椎侧凸的效果,探讨术中、术后并发症的预防措施。方法:青少年特发性僵硬型胸椎侧凸34例,男5例,女29例;年龄8～21岁,平均14.7岁。均为右侧凸。均采用经前路松解植骨融合联合后路三维矫形内固定治疗,其中前路经胸入路26例,胸腔镜前路松解植骨融合矫形术8例。随访时均摄全脊柱X线片。术前、术后所摄X线片进行以下各项测量指标比较:Cobb角、顶椎的旋转度、下融合椎旋转度、躯干偏移距离。随访时观察有无脊柱失平衡、假关节形成及其他并发症的发生。结果:全部病例均获随访,时间12～39个月,平均22个月。所有患者Cobb角术后平均矫正率80.62%,其中18例患者出现矫正度数丢失,丢失度数3°～10°,平均4.3°(术后平均14.2°,1年后随访平均18.5°)。所有患者术后胸椎生理性后凸得到重建。术后胸椎融合弯顶椎的旋转改善率62.91%,下融合椎旋转改善率47.60%,躯干偏移平均距离3.3mm,未见脊柱失平衡现象。围手术期并发症包括低氧血症1例,胸腔积液2例,均经保守治疗后痊愈。术后6个月肺功能检查,未见有明显下降。脊柱胸弯融合段未发现假关节形成。结论:前路松解联合后路矫形内固定植骨融合治疗青少年特发性僵硬型胸椎侧凸可明显改善顶椎的旋转度,得到满意的三维矫形效果。术前积极准备、合理手术设计,术中严格操作,术后重视预防并发症能减少手术并发症的发生。Objective： To evaluate the clinical outcomes of anterior release and posterior three-dimensional（3 D） correction for rigid thoracic adolescent idiopathic scoliosis and explore the prevention of perioperative complications. Methods ： Thirty-four patients with thoracic adolescent idiopathic scoliosis were retrospective analyzed. There were 5 males and 29 females with an average age of 14. 7 years（ from 8 to 21 years）. All cases were idiopathic right thoracic scoliosis. The scoliosises were treated with anterior release and posterior correction（26 cases with thoracotomic and 8 cases thoracoscope）. The Cobb＇s angles, apical and end vertebra rotation, trunk shift were respectively measured at the preoperative, postoperative and final follow-up. Perioperative and postoperative complications were documented. Results：All the patients were followed up for 12 -39 months with an average of 22 months. The average postoperative correction rate was 80. 62%. At the final follow-up, the average Cobb＇s angle of the thoracic curve were 18. 5° 18 cases ,with the mean 4. 3° loss of correction. The sagittal thoracic kyphosis the all cases was improved after operation. The correction rate of the apical and the end vertebra rotation were 62. 91% and 47.60%. The trtmk shift was 3 mm after surgery. Perioperative complication including hypoxemia in 1 case and pleural effusion in 2 cases were cured by conservative treatment. No spine imbalance and other complications were found. Conclusion： Anterior release and posterior 3D correction for the treatment of thoracic adolescent idiopathic scoliosis may improve obviously apical vertebral rotation and obtain satisfactory correction effect. Active preparation, reasonable design, and careful operation are the key points for decreasing the occurance of complications.

关 键 词：脊柱侧凸 矫形外科 青少年 内固定 骨移植 

分 类 号：R682.13[医药卫生—骨科学]