前后路矫形融合术治疗胸腰段／腰段青少年特发性脊柱侧凸（PUMC Ⅰb／Ⅰc／Ⅱd1型）  

Anterior spine fusion versus posterior spine fusion with pedical screws for lumbar and thoracolumbar adolescent idiopathic scoliosis

作　　者：邱贵兴[1] 王以朋[1] 费琦[1] 沈建雄[1] 仉建国[1] 赵宏[1] 赵宇[1] 赵栋[1] 李佳忆[1] 

机构地区：[1]中国协和医科大学北京协和医院骨科,100730

出　　处：《中华骨科杂志》2007年第10期743-747,共5页Chinese Journal of Orthopaedics

摘　　要：目的比较前后两种入路及手术方法治疗特发性胸腰段／腰段脊柱侧凸的疗效。方法青少年特发性脊柱胸腰段／腰段侧凸（PUMC Ⅰb，Ⅰc，Ⅱd1型）患者28例，分为两组。A组16例，平均14．88岁，行前路短节段矫形融合术；B组12例，平均15．50岁，行后路、椎弓根系统矫形融合术。两组均采用第三代坚强矫形内固定器械。比较两组术前一般资料和术中情况，并通过X线参数，比较两种手术的矫形效果和躯干平衡的矫正情况。结果两组术前资料无显著差异，术后均无严重手术并发症，融合效果满意。A组手术时问、术中出血及输血量、内固定材料花费明显少于B组；A组平均融合4．25个节段，B组平均融合5．95个节段。随访时间12-47个月，A组术后冠状面矫正率是82％，随访时72％；B组术后冠状面矫正率是74％，随访时70％。矢状面矫形效果均满意，两组无显著性差异；A组术后即刻躯干偏移矫正不如B组，但随访时，两组无差异。两组在矫正顶椎旋转和顶椎偏移方面无显著差异。结论前路矫形和后路椎弓根系统矫形融合术治疗轻中度胸腰段／腰段青少年特发性脊柱侧凸，均可获得满意的矫形效果，但前路融合可缩短手术时间和减少术中出血、输血量，并能保留较多运动节段。Objective To evaluate and compare the radiological and clinical outcomes of anterior spine fusion versus posterior spine fusion for lumbar and thoracolumbar （PUMC Ⅰb/Ⅰ c/Ⅱ dl type）adolescent idiopathic scoliosis. Methods We performed a retrospective review of the radiological and medical records of 28 patients （two curve-matched groups） with lumbar or thoracolumbar（PUMC type Ⅰ b/Ⅰc/Ⅱ dl ） adolescent idiopathic scoliosis, which were divided into two groups （A and B）. 16 patients （group A） with a mean age of 14.88 years underwent anterior spine fusion（ASF） accoding to the criteria of PUMC classification and 12 patients（group B） with a mean age of 15.50 years underwent posterior spine fusion（PSF） with pedical screws. We evaluated Cobb angels, sagittal alignment including thoracic kyphosis（T5-T12） and lumbar lordosis （L1-L5）, fusion levels, measures of trunk shift（TS）, measures of apical vertebra rotation（AVR） and apical vertebra translation （AVT）, surgical situation including operative time and the volume of intraoperative bleeding and transfusion, implant cost, et al between two groups. Results There was no difference in preopertive general deta between two groups. There were no pseudoarthoses, no reoperation, no neurological complications, no infection, no problem with screw placement, and excellent clinical fusion results in all patients at final follow-up. Group A had less operative time, less volume of intraoperative bleeding and transfusion, less cost of internal implant than group B（P〈 0.05）. Additionally, group A had shorter fusion levels than group B（P〈 0.01）. The average coronal correction of thoracolumbar/lumbar curves was 82% postoperatively and 72% at follow-up in group A and 74% postoperatively and 70% at follow-up in group B（P 〉0.05）. There was no significant difference in the correction of sagittal alignment, TS, AVT and AVR at last follow-up between two groups. Conclusion In this curve-matched cohort of PUMC type Ⅰ b

关 键 词：腰椎 脊柱侧凸 脊柱融合术 内固定器 青少年 

分 类 号：R686[医药卫生—骨科学]