椎弓根螺钉内固定材料置入并植骨融合后路矫正治疗重度僵硬性青少年特发性脊柱侧凸20例(英文)  

Posterior correction using pedicle screw fixation combined with bone grafting and fusion for treatment of severe and rigid adolescent idiopathic scoliosis in 20 cases

作　　者：臧危平[1] 刘祖德[1] 李展春[1] 冯宇[1] 张磊[1] 

机构地区：[1]上海交通大学医学院附属仁济医院骨科,上海市200127

出　　处：《中国组织工程研究与临床康复》2008年第4期755-759,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:主弯Cobb角大于65°、柔韧性小于34.5%的重度僵硬性青少年特发性脊柱侧凸多以传统的前后联合入路手术矫正,但并发症较多。应用使单纯后路手术对矫正置入椎弓根螺钉固定材料植入并植骨融合是否会有更好的效果?目的:评价单纯后路矫正椎弓根螺钉固定材料并植骨融合术矫正治疗重度僵硬性青少年特发性脊柱侧凸的效果。设计:病例分析。单位:上海交通大学医学院附属仁济医院骨科。对象:选择1999-06/2005-08在上海交通大学医学院附属仁济医院骨科收治的20例重度僵硬性青少年特发性脊柱侧凸患者,男8例,女12例,年龄12～18岁,平均15岁。均经全脊柱X片确诊。King-Moe分型Ⅰ型4例,Ⅱ型6例,Ⅲ型5例,Ⅳ型3例,Ⅴ型2例。术前侧凸主弯平均Cobb角82°(75o～92o),平均柔韧性为30%(20%～40%),术前平均双肩高度差为15mm(5～35mm)。患者中Risser征1度3例,2度5例,3度6例,4度5例,5度1例。患者及家属均对治疗知情同意,实验经过医院伦理委员会批准许可。本组患者所用的人工骨为美国Wright公司的产品Osteoset。方法:患者均行单纯后路矫正椎弓根螺钉固定植骨融合手术,暴露预定融合范围内椎体的棘突、椎板、关节突关节及横突。暴露完成后先根据进钉点的解剖标志以徒手技术在术前确定的"关键性椎体"上置入椎弓根螺钉。其中6例手术以TSRH系统进行固定,其余手术均以CDHM8系统固定。术后评估手术时间及失血量。术后7d采用X线测量患者Cobb角,计算主弯矫正率,同时评估双肩高度差及住院时间。术后4年随访患者并发症及恢复情况。主要观察指标:①手术时间及失血量。②Cobb角及主弯矫正率。③双肩高度差及住院时间。④随访结果。结果:患者20例均进入结果分析。①手术时间及失血量:手术时间为3.2～4.3h,平均3.5h;失血量为660～1070mL,平均865mL。②Cobb角及主弯矫正率:术后主弯平均Cobb�BACKGROUND： Traditional anterior release followed by posterior correction and fusion is frequently used to treat severe and rigid adolescent idiopathic scoliosis, which is considered as Cobb angle of the major curve 〉 65° and flexibility 〈 34.5%; however, there are a great majority of complications. Whether isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion may provide better effects on severe and rigid adolescent idiopathic scoliosis needs to be further studied. OBJECTIVE： To evaluate isolated posterior correction using pedicle screw fixation combining with bone grafting and fusion for the treatment of severe and rigid adolescent idiopathic scoliosis. DESIGN： Case analysis. SETTING： Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiao Tong University. PARTICIPANTS： Twenty patients with severe and rigid adolescent idiopathic scoliosis, including 8 males and 12 females, were selected from Department of Orthopaedics, Renji Hospital, Medical College of Shanghai Jiaotong University from June 1999 to August 2005. They were 12-18 years old, and the mean age was 14.6 years. All patients were finally diagnosed as X-ray of whole spine. According to King-Moe criteria, patients were classified into type Ⅰ（n =4）, type Ⅱ（n =6）, type Ⅲ （n =5）, type Ⅳ（n =3） and type Ⅴ（n =2）. Before surgery, mean Cobb angle of the major curve was 82° （75°-92°）, mean flexibility was 30% （20%-40%）, and mean shoulder height difference was 15 mm （5-35 mm）. Moreover, according to Risser syndrome, patients were classified into degree 1 （n =3）, degree 2 （n =5）, degree 3 （n =6）, degree 4 （n =5） and degree 5 （n =1）. All patients and their relatives provided the informed consents, and the experiment was approved by the local ethical committee. Artificial bone was Osteoset provided by Wright Company, USA. METHODS： Patients underwent isolated posterior correction using pedicle screw fixation combi

关 键 词：特发性脊柱侧凸 后路矫正 椎弓根螺钉 融合术 骨科植入体 

分 类 号：R617[医药卫生—外科学]