不同时机后路胸廓成形对KingⅡ型脊柱侧凸胸弯顶椎及邻近节段去旋转效果的影响  

Effect of different occasions of posterior thoracoplasty on derotation of thoracic apical and adjacent segmental vertebrae in King Ⅱ scoliosis patients

作　　者：殷海东 黄明光 彭焰[2] 苏培强[2] 杜庆均 杜开利[2] 王新光[2] 黄东生[2] 

机构地区：[1]佛山市顺德区人民医院脊椎外科,广东省佛山市528300 [2]中山大学附属第二医院骨科,广东省广州市510120

出　　处：《中国组织工程研究与临床康复》2008年第28期5549-5553,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：国家自然科学基金资助项目(30700456)~~

摘　　要：背景:随着脊柱三维矫形理论的提出,胸廓成形术日益受到重视,其中后路凸侧胸廓成形可在脊柱侧凸矫形之前或之后进行,目前临床尚无统一时机要求。目的:观察不同时机行后路凸侧胸廓成形对KingⅡ型脊柱侧凸胸弯顶椎及邻近节段去旋转效果的影响。设计、时间及地点:病例对比观察,于2000-01/2007-07在中山大学附属第二医院完成。对象:选择中山大学附属第二医院收治的应用全椎弓根钉技术+凸侧胸廓成形治疗的KingⅡ型脊柱侧凸患者26例,KingⅡA型10例,KingⅡB型16例。方法:根据术中胸廓成形时机分为2组,去旋转前组12例于去旋转前先行凸侧胸廓成形术,去旋转后组14例于去旋转后再行凸侧胸廓成形术。手术方式均为后路全椎弓根钉矫形固定,顶椎及邻近节段采用万向钉固定,术中去旋转采用CD技术,全部病例均未行前路松解。主要观察指标:利用秩和检验比较两组患者的胸弯Cobb角矫正率、顶椎及邻近脊椎去旋转率。结果:①两组患者胸弯Cobb角矫正率差异无显著性意义(P=0.17)。②去旋转前组患者的顶椎及邻近脊椎去旋转率高于去旋转后组(21.4%,15.1%,P=0.026)。结论:后路去旋转前切除顶椎及附近脊椎凸侧肋骨(胸廓成形)可提高KingⅡ型脊柱侧凸患者胸弯顶椎及邻近节段的去旋转效果。BACKGROUND： With the proposing of three dimensional correction theory of spinal column, thoracoplasty has been paid more attention. Posterior convex thoracoplasty can be performed before or after scoliosis correction. OBJECTIVE： To study the effect of posterior thoracoplasty on different occasions on derotation of thoracic apical and adjacent segmental vertebrae in King Ⅱ scoliosis. DESIGN, TIME AND SETTING： The control case experiment was performed at the Second Hospital Affiliated to Sun Yat-sen University from January 2000 to July 2007. PARTICIPANTS： Totally 26 cases of King Ⅱ scoliosis （Ⅱ A 10 cases, Ⅱ B 16 cases）, who underwent all pedicle screws correction and convex thoracoplasty at the Second Hospital Affiliated to Sun Yat-sen University, were enrolled in this study. METHODS： Patients were divided into two groups. Twelve patients in the pre-derotation group received convex thoracoplasty before derotation, whereas fourteen patients in the post-derotation group received convex thoracoplasty after derotation. Surgery mode was posterior pedicle screw fixation. Apical and adjacent segmental vertebrae were fixed by universal screw. Derotation was conducted by CD technique. None of a patient received anterior release. MAIN OUTCOME MEASURES： Major thoracic curve Cobb angle, apical and adjacent segmental vertebrae derotation angle were compared between the two groups by rank-sum test. RESULTS： The thoracic Cobb angle correction rate in two groups had no significant difference （P=0.17）. Apical and adjacent segmental vertebrae derotation rate in pre-derotation group was much higher than that in post-derotation group （21.4%, 15.1%, P=0.026）. CONCLUSION： Convex thoracoplasty before posterior derotation can improve the derotation effect for King Ⅱ scoliosis on apical and adjacent segmental vertebrae.

关 键 词：胸廓成形术 脊柱侧凸 外科学 

分 类 号：R687.37[医药卫生—骨科学]